Surgical microscopic system

ABSTRACT

Provided is a surgical observational system capable of effectively displaying, in the field of an operating microscope, a real-time image obtained by means of an ultrasonic probe, for example, and a slice image obtained by a preoperative diagnosis on the location of the distal end portion of the probe or a three-dimensional image of an affected region, in association with an actual observational image obtained by means of the microscope. The surgical operation observational system is provided with two monitors in the operating microscope for the observation of the affected region to be operated. Images on the two monitors are alternatively superposed on the optical path of the operating microscope.

[0001] This application is a division of application Ser. No. 09/663,676filed on Sep. 18, 2000.

CROSS-REFERENCE TO RELATED APPLICATION

[0002] This application is based upon and claims the benefit of priorityfrom the prior Japanese Patent Applications No. 11-266687, filed Sep.21, 1999; No. 11-288328,filed Oct. 8, 1999; No. 11-298250, filed Oct.20, 1999; No. 11-312443, filed Nov. 2, 1999; No. 11-353212, filed Dec.13, 1999; and No. 11-354414, filed Dec. 14, 1999, the entire contents ofwhich are incorporated herein by reference.

BACKGROUND OF THE INVENTION

[0003] The present invention relates to a surgical microscopic systemadapted for microsurgery carried out under microscopic observation forneurosurgery, for example.

[0004] In order to ensure higher accuracy for a neurosurgical operationthat uses an operating microscope, for example, treatment based on anendoscope, ultrasonic diagnostic apparatus, or any other diagnostictechnique without the use of visible light is expected to be carried outfor the tissues of regions that are not accessible to the operatingmicroscope, such as the back or inside of an affected region,accompanied by real-time observation and diagnosis. Various surgicalmicroscopic systems have been developed to meet this requirement.

[0005] Described in Jpn. Pat. Appln. KOKAI Publications Nos. 62-166310,3-105305, 7-261094 are surgical observational systems in which anendoscope or the like is used to observe regions that correspond to deadangles of an operating microscope, and optical images of theobservational regions are projected in the field of the microscope.

[0006] According to these conventional surgical observational systems,however, an observational image obtained by means of the endoscope orthe like is only projected on the microscopic field, so that it isdifficult for an operator to identify the endoscopic image that isactually observed through the field of the microscope. In the case wherethis technique is applied to a diagnostic apparatus, such as anultrasonic diagnostic apparatus, which uses no visible light, theoperator can hardly grasp an actually diagnosed part of a patient's bodyaccording to an image in the observational field only. Thus, theoperator can discriminate the diagnosed region by the image only if s/heideally superposes the characteristic features of the diagnostic imageand the actual observational image, based on his or her experience.

[0007] Described in Jpn. Pat. Appln. KOKAI Publication No. 9-56669,moreover, is a surgical microscopic system with improved operativity, inwhich an endoscopic image or the like is displayed as a sub-picture insome other part of the microscopic field than the field portion where amain observational image is displayed. If the operator uses the systemin combination with an endoscope or ultrasonic observer in this case,however, s/he is not provided with any means for grasping the regionthat is observed actually. Therefore, the operator can grasp theobservational region only by randomly swinging the endoscope orultrasonic probe in all directions and ideally superposing thecharacteristic features in comparison with a microscopic image.

[0008] Further, a method for guiding second observational means, such asan ultrasonic probe, into the field of an operating microscope isdescribed in Jpn. Pat. Appln. KOKAI Publication No. 6-209953. Accordingto this conventional technique, however, there is provided no method foreffectively displaying the observational image of the secondobservational means in the microscopic field, so that the operator cancorrelate the microscopic optical image and the image of the secondobservational means only ideally.

[0009] Proposed in Jpn. Pat. Appln. No. 11-132688 filed by the assigneeof the present invention ( , 1999, not published), furthermore, is asurgical microscopic system in which the direction of the observationalfield of an endoscope is indicated by an arrow or the like displayed inthe field of a microscope. However, the microscopic optical image andthe endoscopic image cannot be satisfactorily correlated by onlyindicating the observational direction in this manner. Thus, theoperator can correlate these images only ideally in consideration ofdifferences in rotation, magnification, etc. between them. If anultrasonic observer is used as auxiliary observational means, moreover,the observational direction is not fixed, covering the circumferentialangle of 360°, for example, so that it is hard to align observationalimage and an actual affected region.

[0010] Described in Jpn. Pat. Appln. KOKAI Publication No. 6-205793,moreover, is a display system that displays a preoperative diagnosticimage by superposition on an image of an affected region by means of ahalf-mirror. Since the preoperative diagnostic image is superposed onthe whole affected region image in this case, however, the microscopicfield is too obscure to ensure a satisfactory actual surgical operation.Therefore, this system can only determine a preoperative position forcraniotomy, and cannot accurately grasp information on the inner tissuein association with the affected region on a real-time basis during thesurgical operation.

[0011] Described in Jpn. Pat. Appln. KOKAI Publication No. 9-24052,furthermore, is a method that uses fluorescent observation for therecognition of the position of a cerebral tumor, in order to extract thetumor securely under surgical microscopic observation. Although theobservational tumor position can be securely recognized by this method,however, the obtained information is related only to the exposed surfaceof the tumor on the plane of observation at that time (during theextraction). Accordingly, information on the entire tumor (includinginformation on inaccessible depths) inevitably depends on preoperativeinformation.

[0012] Further, a navigation apparatus is proposed in Jpn. Pat. Appln.No. 10-248672 (filed , 1998, not published). This navigation apparatusforms three-dimensional image data on the basis of image informationfrom a CT scanner or MRI that is operated for a preoperative diagnosis,establishes a spatial correlation between a patient's head and theobservational position of a microscope during a surgical operation, andsupports the surgical operation in accordance with the three-dimensionalimage data. According to this navigation apparatus, the image of theentire tumor is obtained as slice image information for theobservational point concerned during the surgical operation. However,only the slice image information for a focal position can be obtained ona three-dimensional observational plane of the operating microscope.Therefore, the operator must identify the position of the tumor by theslice image information with the progress of the operation.

[0013] With the recent development and spread of microsurgery, atechnique for surgical operations for minute affected regions, moreover,operating microscopes have started to be extensively used formicrosurgery in a wide variety of fields including ophthalmology,neurosurgery, otolaryngology, etc. Naturally, therefore, the operatingmicroscopes are being improved to meet various requirements that dependon operators' surgical maneuvers. Recently, surgical operations havebeen changed into less invasive ones in consideration of earlierrehabilitation of operated patients, so that there is a demand for theway of observation of affected regions in finer tubules. For improvedaccuracy and safety of surgical operations in the depths of the bodycavity, furthermore, hidden regions that are inaccessible to microscopicobservation are expected to made observable.

[0014] As a technique to meet these requirements, a stereoscopicoperating microscope described in Jpn. Pat. Appln. KOKAI Publication No.62-166310, for example, is designed so that the inside of a tubule canbe observed by means of first and second stereoscopic optical systemswith different base line intervals. Since the two stereoscopic opticalsystems shares a finder optical system, moreover, an operator canalternatively observe images from the two optical systems. Thisstereoscopic operating microscope is provided with the stereoscopicoptical system that includes the finder optical system and a pair ofvariable-magnification optical systems, left and right, having the sameoptical axis. An auxiliary stereoscopic optical system that is locatednear the main stereoscopic optical system includes image restoring meansfor reproducing an image from a solid-state image-pickup device forpicking up an image of an observed object and image projecting means forguiding the image to the finder optical system of the stereoscopicoptical system.

[0015] An optical device described in Jpn. Pat. Appln. KOKAIPublications No. 3-105305 is designed so that one or both of images fromtwo observational means of a stereoscopic operating microscope can bealternatively observed and that the operator can select the images bymeans of a footswitch or the like without using his or her hand.

[0016] A system described in Jpn. Pat. Appln. KOKAI Publication No.6-175033, moreover, is provided with position specifying means forspecifying a position in or near the observational field. In thissystem, the relation between a reference position of an operatingmicroscope and the position specified by means of the positionspecifying means is computed, and the body of the microscope is moved tothe specified position.

[0017] Described in Jpn. Pat. Appln. No. 10-319190 filed by the assigneeof the present invention ( , 1998, not published), furthermore, is asystem provided with drive means that causes an operating microscope anda robot manipulator to move to target positions in accordance with apreoperative diagnostic image or slice image information, therebycorrelating the preoperative image and the operative field.

[0018] If the operator uses an auxiliary optical system for tubuleobservation to observe dead-angle regions that are inaccessible tomicroscopic observation, e.g., the back side of the an aneurysm, nervescleared of a tumor, peripheral tissues, etc., as in the prior art casementioned before, a video image picked up by means of an endoscope orother auxiliary optical system is displayed in the microscopic field. Inthis case, the operator's mate sometimes may observe a similar image ass/he aspirates the marrow or blood to secure the operator's field ofvision.

[0019]FIG. 74 shows an example of the system of an operating microscopea of this type. A body b of the microscope a is provided with anoperator eyepiece unit c1 and a mate eyepiece unit c2. An in-fieldmonitor (not shown) is located in a part of the field of each of theeyepiece units c1 and c2. As shown in FIGS. 75A and 75B, indexes andsub-images e1 and e2 that are different from main images d1 and d2 ofthe operating microscope a are projected in the main images d1 and d2.

[0020] An LCD driver f is connected to each in-field monitor. Further, aCCTV unit q is connected to the LCD driver f. A camera head i isconnected to the CCTV unit g. An endoscopic image observed by means ofan endoscope h is displayed on the respective in-field monitors of theoperator and mate eyepiece units c1 and c2.

[0021] When a conventional operating microscope apparatus is used,moreover, an operative field j as an object of a surgical operation isobserved at different angles by means of the microscope body b and theendoscope h. An optical video image then caught by the endoscope h isphotoelectrically converted by means of a image-pickup device (notshown) in the TV camera head i and applied as an electrical signal tothe TV camera head i to be processed therein, whereupon a TV signal isoutputted. This TV signal is converted into a display mode signal of aliquid crystal display device (not shown) by means of the LCD driver f.This signal is delivered to liquid crystal image display devices (notshown) of the respective in-field monitors of the operator and mateeyepiece units c1 and c2 of the microscope a. Thereupon, endoscopicimages are partially displayed as the sub-images e1 and e2 on the mainimages d1 and d2 of the microscope a in the microscopic field, as shownin FIGS. 75A and 75B. More specifically, in the operator eyepiece unitc1 of this operating microscope apparatus, the sub-image e1, anendoscopic image, is inserted into the main image d1 in the field of themicroscope a by means of the liquid crystal image display device (notshown), as shown in FIG. 75A. Likewise, in the mate eyepiece unit c2,the sub-image e2, an endoscopic image, is inserted into the main imaged2 in the field of the microscope a by means of the liquid crystal imagedisplay device (not shown), as shown in FIG. 75B.

[0022] According to this operating microscope apparatus, however, theoperator and the mate have their respective observational directions.Therefore, the relation between the display position of the main imaged1 in the field of the operator eyepiece unit c1 of the microscope a andthe display position of the sub-image e1 in the same field is differentfrom the relation between the display position of the main image d2 inthe field of the mate eyepiece unit c2 of the microscope a and thedisplay position of the sub-image e2 in the same field. Since the fielddirection of the mate is different from that of the operator, theposition in the mate-side observational optical system where thein-field display image appears is inevitably different from thecorresponding position in the operator-side observational opticalsystem. Possibly, therefore, a region that can be observed through theoperator-side optical system may not be able to be observed through themate-side optical system.

[0023] Basically, moreover, the field direction on the mate side isdifferent from the operator-side field direction. Although themicroscope images are located in correct relative positions, therefore,the positional relation between the images obtained by means of theauxiliary optical system cannot be displayed correctly. Since themate-side observational optical system is rotatable with respect to theoperator-side system, furthermore, the positional relation between theimages of the auxiliary optical system goes wrong if the mate-sidesystem is rotated. If bleeding or the like occurs in any regioncorresponding to a dead angle of the image of the auxiliary opticalsystem in the mate-side field, therefore, the display position of theauxiliary optical system must be controlled manually.

[0024] In carrying out a surgical operation with reference to adiagnostic image, furthermore, a preoperative diagnostic image, such asMRI or X-ray CT, sometimes may be display as each of the sub-images e1and e2 on the video images in the main images d1 and d2 in the field ofthe microscope a. In this case, these sub-images, unlike the aforesaidvideo image of the auxiliary optical system, should never fail to beerect images, and the images that are accessible to the operator and themate, individually, must be of the same type.

[0025] In the case where the operating microscope apparatus is used incombination with a position information detector or the like, moreover,a position information detection image and a marker for the detectormust be overlaid on a microscopic image. A conventional microscopicapparatus with in-field display means requires use of one combination ofan optical system and a display device for the display of an image inthe microscopic field and another for the display of a marker. If theimage and the marker are needed simultaneously, therefore, the displaydevice must be changed during use or one of the devices must be replacedwith an alternative device.

[0026] Conventionally, furthermore, the operator is expected to confirmthe marker display of the position information detector and manuallymove the microscope body to the marker position. Accordingly, highlycomplicated maneuvers are required by a technique that uses the positioninformation detector in combination with an auxiliary optical systemsuch as an endoscope.

[0027] In order to make a microsurgical operation less invasive,moreover, various pieces of image information are used during theoperation. The image information may be obtained by means of anendoscope for observing regions that are inaccessible to the operatingmicroscope or an ultrasonic observer for obtaining a slice image of theinside of tissue. Further, it may be obtained by means of a diagnosticdevice such as a so-called nerve monitor device for measuring thepotential of nerves of a patient under the operation. To attain this, anoperating microscope for the observation of an endoscopic image or thelike is described in Jpn. Pat. Appln. KOKAI Publication No. 10-333047,as in Jpn. Pat. Appln. KOKAI Publication No. 62-166310.

[0028] A microscope requires visibility adjustment or adjustment ofdifferences in eyesight (refractive force) between observers. Atechnique for this visibility adjustment is described in Jpn. Pat.Appln. KOKAI Publication No. 7-281103. An operating microscope is alsosubjected to the visibility adjustment with every surgical operation. Onthe other hand, a method for measuring the refractive force of an eye isdescribed in Jpn. Pat. Appln. KOKAI Publication No. 3-200914. In thismethod, however, the refractive force of an eye of a patient, not anobserver, is measured by projecting an index on the eyeground anddetecting light reflected by the eyeground.

[0029] The operating microscope described in Jpn. Pat. Appln. KOKAIPublication No. 10-333047 can perform microscopic observation andendoscopic observation in one and the same field. When an endoscope ismoved in an affected region, however, its distal end must be checked forthe location on a microscopic image lest it damage tissue as anendoscopic image is observed. It is to be desired, therefore, that theendoscopic image should not intercept the microscopic field or should bedisplayed small on the microscopic image.

[0030] When the endoscopic image is watched as a treatment or the likeis carried out, on the other hand, it is expected to be wide enough.Observation based on the microscopic image is also needed to check aninstrument for insertion or watch a wide range of the affected region.Thus, it is advisable to display the endoscopic image large on themicroscopic image.

[0031] In each of the operating microscopes described in Jpn. Pat.Appln. KOKAI Publications Nos. 62-166310 and 10-333047, however, theendoscopic image is displayed in a fixed position and within a fixedrange in the microscopic field. Therefore, a surgical operation usingthe endoscope cannot easily meet the demand for both the movement of theendoscope and the treatment with reference to the endoscopic image, andthe endoscopic image may be obstructive or too small for smoothtreatment.

[0032] Thus, it is hard for an operator to concentrate his or herattention on the surgical operation, so that the operator's fatigueincreases, and the operation time extends. An ultrasonic diagnosticapparatus is subject to the same problems when its probe is moved orwhen ultrasonic observation or treatment under ultrasonic observation iscarried out. Since the endoscope used under surgical microscopicobservation is designed for the observation of regions corresponding todead angles of the microscope, moreover, it should be of a squint typefor observation in directions different from the direction of itsinsertion. If the squint-type endoscope is rotated around the directionof insertion, it ceases to be able to identify the direction of viewwith respect to the microscopic field. Accordingly, the operator mustjudge the observational direction by a tissue form displayed in theendoscopic image. Thus, it is hard for the operator to be devoted to thesurgical operation, so that the operator's fatigue increases, and theoperation time extends. Even when the operator is concentrating his orher attention on the observational image of the operating microscope,furthermore, s/he must also pay attention to the state of some otherequipment to detect a change in the nerve monitor device, so that his orher fatigue is increased.

[0033] On the other hand, the conventional visibility adjustmentoperation described in Jpn. Pat. Appln. KOKAI Publication No. 7-281103is troublesome and lengthens the setup time before the start ofoperation of the operating microscope. If the operator changes during asurgical operation, moreover, the visibility must be readjusted.Usually, it is difficult to adjust the visibility with a drape forsterilization on the microscope. If the microscope is used with wrongvisibility, the surgical operation is performed with the right or lefteye of the operator out of focus, so that the operator is fatigued much.Further, a TV camera or 35-mm camera that is connected to the operatingmicroscope may fail to be in focus. In this case, the refractive indexof the operator's eye may be able to be measured automatically tocorrect the visibility by the method described in Jpn. Pat. Appln. KOKAIPublication No. 3-200914. According to this method, however, an opticalsystem must be provided with an index projection optical system fordetection and its mating light receiving optical system, so that alarge-sized apparatus is required, constituting a hindrance to thesurgical operation. Even if projected light has a wavelength in aninvisible zone, its influence upon the observational performance of themicroscope cannot be removed thoroughly, so that the efficiency of thesurgical operation is lowered, and the operator is fatigued inevitably.

[0034] A rigid scope may be used for the observation of regionscorresponding to dead angles of the operating microscope inmicrosurgery. In this case, the observation of the dead-angle regionsrequires use of a so-called squint-type rigid scope for obliqueobservation at a fixed angle (e.g., 30°, 70° or 110°) to theobservational optical axis of its eyepiece. In this rigid scope, a TVcamera (image-pickup device) is connected to the eyepiece to display itsobservational image on a monitor screen. The rigid scope is alsoconnected with a light guide, which is connected to a light source unitto guide illumination light to an affected region. In order to observe aregion corresponding to a dead angle of the operating microscope, therigid scope of this type is used in a very narrow space (normally about300 mm) between the body of the microscope and the observational region.To change its squint angle, moreover, the rigid scope can be rotatedthroughout the angular range of 360° with respect to the direction ofits insertion during a surgical operation. Thus, the operator canobserve his or her desired position.

[0035] In a rigid scope described in Jpn. UM Appln. KOKAI PublicationNo. 5-78201, a TV camera is connected optically to the imaging point ofits eyepiece. A light guide that constitutes an illumination opticalsystem in the rigid scope and a light guide one end of which isconnected to a light source unit are connected optically to each otherin a position near the eyepiece. Since the TV camera itself projects inthe direction of insertion of the rigid scope, however, it may possiblyinterfere with the operating microscope body, depending on the directionof insertion of the scope into the body cavity, so that the operator'sdesired observational position is restricted inevitably. Further, thelight guide that is connected to the light source unit projectssubstantially at right angles to the direction of insertion into thebody cavity. If the operator rotates the rigid scope around thedirection of insertion to change the observational direction, therefore,the light guide may get deep into the field of the microscope dependingon its direction, thereby hindering the microscopic observation.

[0036] In a rigid scope described in U.S. Pat. No. 5,168,863, moreover,cables of a TV camera that is connected to an eyepiece are guided in adirection at about 45° to its longitudinal direction (direction ofinsertion into the body cavity). In this case, the TV camera cansomewhat be prevented from interfering with the body of an operatingmicroscope. Nevertheless, the TV camera itself still causesinterference, and the light guide extensively intercepts the microscopicfield as the rigid scope rotates.

[0037] In a rigid scope described in Jpn. UM Appln. KOKAI PublicationNo. 56-176703, furthermore, a reflective member for bending theobservational optical axis is disposed on an observational opticalsystem therein so that the optical axis of an eyepiece is inclined at afixed angle to the longitudinal direction of the scope (direction ofinsertion into the body cavity). Since the a part of the eyepieceportion of this rigid scope is inclined at the fixed angle to thedirection of insertion of the scope, a TV camera can avoid interferingwith the body of an operating microscope. Since the direction ofprojection of a light guide is coincident with the direction ofinsertion into the body cavity, however, the light guide and themicroscope body inevitably interfere with each other.

[0038] A rigid scope described in Jpn. Pat. Appln. KOKAI Publication No.11-155798, like the one described in Jpn. UM Appln. KOKAI PublicationNo. 56-176703, is designed so that the observational optical axis of aneyepiece is inclined at a fixed angle to its longitudinal direction(direction of insertion into the body cavity), and a light guide, whichis connected to a light source unit, is connectable near the eyepiece.In either of the rigid scopes described in Jpn. UM Appln. KOKAIPublication No. 56-176703 and Jpn. Pat. Appln. KOKAI Publication No.11-155798, however, the eyepiece and the TV cam attached thereto projectlong within a plane at about 90° to the direction of insertion of therigid scope into the body cavity (i.e., region for the operator'ssurgical operation), so that they inevitably intercept the space for thesurgical operation, thereby hindering the operation. When the operatorrotates the rigid scope around the direction of insertion into the bodycavity to change the observational direction, in particular, the scopemoves in an arc of a circle having a radius that is equal to the sum ofthe respective overall lengths of the eyepiece, TV camera, cables, etc.,thus constituting a great hindrance to the operation. Depending on theobservational direction, moreover, the TV camera and the light guide mayinterfere with the operator's hand or body, so that they may possiblylower the efficiency of the surgical operation.

BRIEF SUMMARY OF THE INVENTION

[0039] The present invention has been contrived in consideration ofthese circumstances.

[0040] An object of the present invention is to improve the efficiencyof a surgical operation by simultaneously displaying a plurality ofpieces of information required by an operator in the field of amicroscope during microsurgery so that the operator can be fed withnecessary information as required.

[0041] Another object of the invention is to display a real-timeobservational image of second observational means effectively inassociation with an observational image of first observational means inthe field of the first observational means in a microscope body.

[0042] Still another object of the invention is to provide a surgicalmicroscopic system designed so that an operator can easily grasp theprogress of an surgical operation during the operation, whereby theoperation can be carried out more securely and safely.

[0043] A further object of the invention is to provide a surgicalmicroscopic system designed so that necessary in-field information canbe appropriately offered to an operator or his or her mate, and that arequired microscopic field can be easily secured during a surgicaloperation.

[0044] An additional object of the invention is to provide a surgicalmicroscopic system designed so that an operator can be devoted to asurgical operation, his or her fatigue can be eased, and the operationtime can be shortened.

[0045] Furthermore, the invention is intended to improve a rigid scopethat can be inserted into the body cavity under surgical microscopicobservation, thereby enabling observation at a fixed angle to thedirection of insertion, to prevent the rigid scope and a TV camera orlight guides connected thereto from hindering the microscopicobservation or surgical treatment, and to enable an operator to observea desired position with ease.

[0046] In order to achieve the above objects, according to an aspect ofthe invention, there is provided an operating microscope apparatuscomprising: at least one microscope body defining an observational fieldfor observing an affected region; first image display means fordisplaying a first image in the observational field; second imagedisplay means for displaying a second image in the observational field;and image display control means for displaying independent images on thefirst and second image display means, individually.

[0047] The microscope body may include an optical image displayed in theobservational field. In this case, the operating microscope apparatusmay comprise second observational means different from an operatingmicroscope and selected from a group including an endoscope and anultrasonic probe. Further, the second image display means may include animage superposition optical system for superposing an image on theoptical image in the observational field. Preferably, the image displaycontrol means includes means for independently switching on and off thefirst and second image display means.

[0048] In the case where the operating microscope apparatus comprisessecond observational means different from an operating microscope andselected from a group including an endoscope and an ultrasonic probe,the first and second images preferably include (i) a combination of anobservational image obtained by means of the second observational meansand an image (navigation image) indicative of the observational positionor direction of the second observational means or (ii) a combination ofa tumor position display marker image and a preoperative/mid-operativediagnostic image selected from a group including image-processedfluorescent observational images and the image (navigation image)indicative of the observational position or direction of the secondobservational means.

[0049] According to another aspect of the invention, there is provided asurgical observational system including first observational means forobserving an affected region and second observational means differentfrom the first observational means at least in the observationaldirection or observational method. This system comprises detecting meansfor detecting the respective observational positions and directions ofthe first and second observational means relative to the position of theaffected region; and display means for displaying an observational imageof the second observational means in a given part of an observationalimage of the first observational means in visual correlation based onthe relative positions detected by means of the detecting means.According to this surgical observational system, the image of the secondobservational means is correlatively displayed in a part of theobservational image of the first observational means. Thus, therespective observational positions of the first and second observationalmeans are detected on the basis of the affected region by means of anoptical position detector, for example. The observational image of acorresponding portion of the second observational means can be cut outinto a given position of the observational image of the firstobservational means to adjust the image size for display.

[0050] Alternatively, the surgical observational system may comprisedetecting means for previously storing a preoperative diagnostic imageand detecting the observational position of the second observationalmeans relative to the preoperative diagnostic image; and display meansfor simultaneously displaying the preoperative diagnostic imageconcurrent with the observational position of the second observationalmeans and the observational image of the second observational means inthe field of the first observational means in accordance with therelative positions detected by means of the detecting means. In thiscase, the observational position of the second observational means isdetected on the basis of the affected region by means of an opticalposition detector, for example. The observational image of the secondobservational means is displayed in the field of the observational imageof the first observational means, and at the same time, a part of thepreoperative diagnostic image corresponding to the observationalposition of the second observational means is displayed in theobservational field of the first observational means.

[0051] According to this surgical observational system, at least a partof the observational image of the second observational means isdisplayed in the observational field of the first observational meansfor the observation of the affected region in a manner such that itsposition, size, etc. are associated with those of the observationalfield of the first observational means. Accordingly, the states of deadangle portions and the inside of tissue that cannot be observed by meansof the first observational means can be recognized easily and securely,so that the reliability and efficiency of the surgical operation can beimproved considerably.

[0052] On the other hand, the surgical observational system may comprisedetecting means for detecting the respective observational positions anddirections of the first and second observational means relative to theposition of the affected region; an indicator indicative of an optionalposition in the observational field of the first observational means;and display means capable of following the indicator and displaying anobservational image for a given range in the observational field of thefirst observational means by superposition. According to this surgicalobservational system, as in the case of the system described above, theimage of the second observational means can be correlatively displayedin a part of the observational image of the first observational means.An operator can operate the indicator to set an optional position in theobservational field of the first observational means. The observationalimage of the second observational means is displayed in a given range ofthe indicator after is cut out and subjected to size adjustment. Thus,the affected region in the peripheral portion and the observationalimage of the second observational means can be correlated with ease, andtreatment can be carried out smoothly, so that the efficiency of thesurgical operation can be improved.

[0053] According to still another aspect of the invention, there isprovided an operating microscope apparatus for subjecting an affectedregion to a surgical operation, comprising: a microscope body includinga stereoscopic optical system and used to observe a desired region;position computing means for detecting the position of the observationalregion observed through the stereoscopic optical system and computingthe positional relation between the observational region and adiagnostic image of the affected region; fluorescent shooting means forshooting fluorescent images of the observational region, therebyobtaining fluorescent observational images; and display means fordisplaying, by superposition, the diagnostic image corresponding to theposition of the observational region detected. by means of the positioncomputing means and the fluorescent observational images obtained bymeans of the fluorescent shooting means.

[0054] This operating microscope apparatus may comprise storage meansfor storing the fluorescent observational images. In this case, thedisplay means displays the diagnostic image corresponding to theobservational position detected by means of the position computing meansand the fluorescent observational images stored in the storage means, bysuperposition on the observational image of the affected region.Further, the operating microscope apparatus may comprise display modesetting means capable of setting an optional display mode. In this case,the display means displays the diagnostic image corresponding to theobservational position detected by means of the position computing meansand the fluorescent observational images stored in the storage means, bysuperposition on the observational image of the affected region, inaccordance with the setup state of the display mode setting means.

[0055] According to this operating microscope apparatus, the fluorescentobservational images shot by means of the fluorescent shooting means andthe diagnostic image selected according to the observational positiondetected by means of the position computing means are displayed bysuperposition, so that the operator can accurately recognize theconditions of a tumor to be extracted. Thus, the operator can carry outextraction more accurately and be devoted to the extracting operation.Further, only the tumor portion can be extracted securely, so that theobject for minimally invasive surgery can be achieved.

[0056] According to the present invention, moreover, there is providedan operating microscope apparatus for subjecting an affected region to asurgical operation, comprising: a microscope body including astereoscopic optical system and used to observe a desired region;position computing means for detecting the position of the observationalregion observed through the stereoscopic optical system and computingthe positional relation between the observational region and adiagnostic image of the affected region; fluorescent shooting means forstereoscopically shooting fluorescent images of the observationalregion, thereby obtaining fluorescent observational images; storagemeans for storing the fluorescent observational images; image dividingmeans for dividing the diagnostic image corresponding to theobservational position detected by means of the position computing meansinto two image signals having a lateral parallax; and display means fordisplaying the individual stored fluorescent observational images andthe laterally divided diagnostic images by superposition on theobservational image of the affected region.

[0057] Likewise, there is provided an operating microscope apparatus forsubjecting an affected region to a surgical operation, comprising: amicroscope body including a stereoscopic optical system and used toobserve a desired region; position computing means for detecting theposition of the observational region observed through the stereoscopicoptical system and computing the positional relation between theobservational region and a diagnostic image of the affected region;fluorescent shooting means for stereoscopically shooting fluorescentimages of the microscopic observational region, thereby obtainingfluorescent observational images; storage means for storing thefluorescent observational images; display mode setting means capable ofsetting an optional display mode; image dividing means for dividing thediagnostic image corresponding to the observational position detected bymeans of the position computing means into two image signals having alateral parallax; superposing means for superposing the individualstored fluorescent observational images and the laterally divideddiagnostic images on the observational image of the affected region inaccordance with the setup state of the display mode setting means; and alens tube portion having a monitor portion for displaying the individualimages.

[0058] The fluorescent shooting means may be designed for stereoscopicshooting of the fluorescent images of the observational region. In thiscase, the operating microscope apparatus comprises image dividing meansfor dividing the diagnostic image corresponding to the observationalposition detected by means of the position computing means into twoimage signals having a lateral parallax. The display means can displaythe individual stored fluorescent observational images and the laterallydivided diagnostic images by superposition on the observational image ofthe affected region.

[0059] Further, the operating microscope apparatus may comprise a lenstube portion having a monitor portion for displaying the individualimages.

[0060] Furthermore, the display means may be designed to display, bysuperposition, the slice image corresponding to the observationalposition detected by means of the position computing means and thefluorescent observational images obtained by means of the fluorescentshooting means. This operating microscope apparatus may comprise displaymode setting means capable of setting an optional display mode. In thiscase, the display means displays the slice image corresponding to theobservational position detected by means of the position computing meansand the fluorescent observational images stored in the storage means, bysuperposition on the observational image of the affected region, inaccordance with the setup state of the display mode setting means.

[0061] According to a further aspect of the invention, there is providedan operating microscope apparatus including a plurality of eyepieceunits capable of relative movement and individually having fieldscapable of displaying one and the same region as a main image andin-field monitors provided individually for the eyepiece units and eachadapted to project an index and/or a sub-image different from the mainimage on a part of the field, comprising: input means for applyingobservation conditions to one of the eyepiece units; and observationalstate changing means for changing the observational state of the othereyepiece unit according to the conditions. Thus, necessary in-fieldinformation can be appropriately offered to the operator or his or hermate, and a target microscopic field can be easily secured during asurgical operation.

[0062] Preferably, the observational state changing means includesdetecting means for detecting the position of the one eyepiece unitrelative to the other eyepiece unit, an in-field display control meansfor controlling the display position of the in-field monitor of at leastthe one eyepiece unit to change the observational region in accordancewith the result of detection by the detecting means, shielding means forselectively intercepting the optical image of the eyepiece units, andimage rotating means for rotating the image of the in-field monitor inresponse to the output of the position detecting means. In this case, anoptimum image display method can be provided even for a fixed-directionimage, such as a preoperative image, and overlay display of the index bymeans of a position information detector and the operation of thedetector can be carried out with ease. Further, the display method cansecure a satisfactory degree of freedom for the operator and the mate.

[0063] The sub-image may be a diagnostic image. Preferably, in thiscase, the operating microscope apparatus comprises index manipulatingmeans for changing the in-field index position on the diagnostic imageand a position information computing unit for computing thethree-dimensional position of an actual affected region relative to theposition of the index displayed by means of the index manipulatingmeans, and the position information computing unit and the in-fielddisplay control means drive the observational region of the operatingmicroscope to the three-dimensional position.

[0064] Preferably, the operating microscope apparatus further comprisesan image processing unit for image map conversion, adapted synchronouslyto rotate the image of the in-field monitor and the shielding meansformed of the liquid crystal device in response to the output of therelative position detecting means.

[0065] According to an additional aspect of the invention, there isprovided an operating microscope comprising: a first observationaloptical system for optically enlarging an affected region; a secondobservational optical system for observing optional image informationfrom an external apparatus; and an eyepiece optical system forsimultaneously observing observational images of the first and secondobservational optical systems, the second optical system includingdisplay state changing means capable of changing the display state ofthe image information from the external apparatus in accordance withoperation information from the external apparatus. The first and secondobservational optical systems are different from each other.

[0066] According to this operating microscope, if the operating state ofthe external apparatus is changed when the observational images of thefirst and second observational optical systems are simultaneouslydisplayed, the image observed by means of the second observational meansis automatically changed into a suitable state for a surgical operation.A small endoscopic image is displayed when an endoscope is moved in theaffected region, for example. The displayed endoscopic image is largeenough when it is watched as treatment or the like is carried out. Thus,according to this operating microscope, the display state of the displayimage in the microscopic field can be automatically changed inaccordance with the operating state of the external apparatus, so thatthe operator can be devoted to the surgical operation, his or herfatigue can be eased, and the operation time can be shortened. Thismicroscope is particularly serviceable if it is used with an ultrasonicobserver for obtaining a slice image of the inside of tissue or aso-called nerve monitor device for measuring the potential of nerves ofa patient under the operation, as well as the endoscope for observingregions that are inaccessible to the operating microscope.

[0067] Further, there is provided an operating microscope comprising: afirst observational optical system for enlarged-scale opticalobservation of an affected region; a second observational optical systemfor observing optional image information from an external apparatus, thesecond observational optical system being different from the firstobservational optical system, and an eyepiece optical system forsimultaneously observing observational images of the first and secondobservational optical systems. The second optical system includesfixed-view image display means for an observer's close observation, anindex projection optical system for the eyeground, and an imagereceiving optical system for receiving reflected light from theeyeground. The operating microscope further comprises detecting meansfor computing refractive force in accordance with information from theimage receiving optical system and visibility adjustment drive controlmeans for driving a visibility adjustment mechanism in accordance withinformation from the detecting means. According to this operatingmicroscope, the sight or refractive force of an observing eye ismeasured through the second observational optical system. Based on thisrefractive force, the visibility adjustment drive control meansautomatically carries out visibility adjustment. Thus, the operatingmicroscope can be reduced in size without lowering its observationalperformance, and the operator can concentrate his or her attention onthe operation without fatigue.

[0068] The display state changing means may include operation inputportion for inputting the operation information from the externalapparatus, optical changing means capable of optically changing thedisplay state of the image information of the second observationaloptical system compared to the observational image of the firstobservational optical system, and control means for actuating theoptical changing means in accordance with input information from theoperation input portion. Preferably, the optical changing means includesmagnification changing means capable of changing the magnification ofthe second observational optical system. According to this operatingmicroscope, the size of each endoscopic image in the microscopic fieldcan be changed in accordance with the movement and observational stateof the endoscope. Thus, when the endoscope is moved, a small endoscopicimage is displayed such that the distal end of the endoscope can besatisfactorily observed through the microscope. During endoscopicobservation, on the other hand, a large image is displayed to facilitatetreatment. If a squint-type endoscope for observation in directionsdifferent from the direction of insertion is used and rotated around thedirection of insertion to observe regions corresponding to dead anglesof the microscope, therefore, the observational direction of theendoscope compared to the microscopic field can be identified with ease.

[0069] Preferably, the optical changing means includes magnificationchanging means capable of changing the magnification of the secondobservational optical system or display position changing means capableof changing the position of the second observational optical systemrelative to the first observational optical system. The magnificationchanging means may be lens moving means for moving avariable-magnification optical system constituting the secondobservational optical system. Thus, there is provided an operatingmicroscope in which the observational direction of an endoscope comparedto the microscopic image can be recognized with ease.

[0070] The display position changing means may include rotating meansfor rotating the second observational means around the optical axis ofthe first observational means. Even when the operator is concentratinghis or her attention on the observational image of the operatingmicroscope, in this case, s/he can readily notice a change in the nervemonitor device. Thus, the operator can be devoted to the surgicaloperation, and his or her fatigue can be eased.

[0071] Additional objects and advantages of the invention will be setforth in the description which follows, and in part will be obvious fromthe description, or may be learned by practice of the invention. Theobjects and advantages of the invention may be realized and obtained bymeans of the instrumentalities and combinations particularly pointed outhereinafter.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

[0072] The accompanying drawings, which are incorporated in andconstitute a part of the specification, illustrate presently preferredembodiments of the invention, and together with the general descriptiongiven above and the detailed description of the preferred embodimentsgiven below, serve to explain the principles of the invention.

[0073]FIG. 1 is a view showing an outline of an operating microscope foruse as first observational means of a surgical observational systemaccording to a first embodiment;

[0074]FIG. 2 is a block diagram of the surgical observational systemaccording to the first embodiment;

[0075]FIG. 3 is a detailed view for illustrating a microscope bodyportion of the operating microscope;

[0076]FIGS. 4A and 4B are views showing a state in which the wholesurface of a first liquid crystal shutter is transmittable and a statein which a partial shading portion is provided in the shutter,respectively;

[0077]FIGS. 5A and 5B are views showing a state in which the wholesurface of a second liquid crystal shutter is interceptive and a statein which a partial transparent portion is provided in the shutter,respectively;

[0078]FIGS. 6A and 6B are views individually showing images observed byan operator, in which FIG. 6A shows only an optical image obtained whenthe whole surface of the first liquid crystal shutter is transmittable,and FIG. 6B shows a state in which an image obtained by means of anultrasonic probe is displayed in a microscopic field;

[0079]FIG. 7A is a view showing an image obtained by means of theultrasonic probe and displayed on a monitor;

[0080]FIG. 7B is a view showing a state in which the image obtained bymeans of the ultrasonic probe is reduced to a given size;

[0081]FIG. 8 is a block diagram of a surgical observational systemaccording to a second embodiment;

[0082]FIG. 9 is a detailed view for illustrating a microscope bodyportion of an operating microscope;

[0083]FIGS. 10A to 10C are views individually showing various states ofan image in the microscopic field observed by the operator, in whichFIG. 10A shows an ultrasonic image obtained by means of the ultrasonicprobe, FIG. 10B shows a preoperative diagnostic image, and FIG. 10Cshows the preoperative diagnostic image and the ultrasonic diagnosticimage in association with an actual affected region;

[0084]FIGS. 11A and 11B are views individually showing observationalimages according to the second embodiment, in which FIG. 11A shows theultrasonic probe having its central portion extracted by means of amixer, and FIG. 11B shows an image actually observed by the operator;

[0085]FIG. 12 is a general block diagram of a surgical observationalsystem according to a third embodiment;

[0086]FIG. 13 is a view showing the way an observational image of arigid scope for use as second observational means according to the thirdembodiment is displayed on a monitor;

[0087]FIGS. 14A to 14F illustrate the respective operations of first andsecond liquid crystal shutters according to the third embodiment, inwhich FIGS. 14A and 14B are views showing the relation between a shadingportion and a transparent portion, FIG. 14C is a view showing a state ofdisplay on a monitor, and FIGS. 14D to 14F are views similar to FIGS.14A to 14C, showing the shading portion and the transparent portionshifted in position;

[0088]FIGS. 15A to 15D show images observed by the operator according tothe third embodiment and illustrate various positional relations betweenthe image obtained by means of the rigid scope and an optical imageobtained by means of the microscope;

[0089]FIG. 16 is a view showing a configuration of an operatingmicroscope according to a fourth embodiment of the invention;

[0090]FIG. 17 is a view showing a configuration of an illuminationsystem of the operating microscope;

[0091]FIG. 18 is a view showing a configuration of an observationaloptical system of the operating microscope;

[0092]FIG. 19 is a general functional block diagram of the operatingmicroscope;

[0093]FIG. 20 is a chart for illustrating the operation of theinvention;

[0094]FIG. 21 is a view for illustrating the way of synthesizing afluorescent observational image and a two-dimensional preoperative sliceimage;

[0095]FIG. 22 is a view showing a configuration of an observationaloptical system according to a fifth embodiment of the invention;

[0096]FIG. 23 is a general functional block diagram of an operatingmicroscope;

[0097]FIG. 24 is a general functional block diagram of an operatingmicroscope according to a sixth embodiment of the invention;

[0098]FIG. 25 is a three-dimensional exterior view of a tumor;

[0099]FIG. 26 is a view for illustrating the effect of the sixthembodiment of the invention;

[0100]FIG. 27 is a side view showing the general external appearance ofan operating microscope apparatus according to a seventh embodiment ofthe invention;

[0101]FIG. 28 is a side view showing a configuration of a microscopebody of the operating microscope apparatus according to the seventhembodiment;

[0102]FIG. 29 is a schematic view of an optical system of the operatingmicroscope apparatus according to the seventh embodiment;

[0103]FIG. 30 is a block diagram of an electric circuit of the operatingmicroscope apparatus according to the seventh embodiment;

[0104]FIG. 31A is a plan view showing a state in which a mask portion isinserted in a microscopic image of an operator-side optical system ofthe operating microscope apparatus according to the seventh embodiment;

[0105]FIG. 31B is a plan view showing plan view showing a state in whichan endoscopic image is partially displayed on an in-field image;

[0106]FIGS. 31C and 31D are plan views showing images obtained byrotating the images of FIGS. 31A and 31B, respectively;

[0107]FIGS. 32A and 32B show in-field images in a state such thatendoscopic images are inserted individually in operator- and mate-sidemicroscopic images of the operating microscope apparatus according tothe seventh embodiment;

[0108]FIGS. 33A and 33B are plan views showing operatorand mate-usemicroscopic images, respectively, in the operating microscope apparatusaccording to the seventh embodiment;

[0109]FIGS. 34A and 34B are plan views showing a mask image and ain-field display image, respectively, obtained when an index is overlaidon each microscopic image in the operating microscope apparatusaccording to the seventh embodiment;

[0110]FIGS. 35A and 35B are plan views showing indexes superposedindividually on the operator- and mate-use microscopic images,respectively, in the operating microscope apparatus according to theseventh embodiment;

[0111]FIG. 36 is a schematic view of a mate-side optical system of anoperating microscope apparatus according to an eighth embodiment of theinvention;

[0112]FIG. 37 is a plan view showing an outline of a drive mechanism fora microscopic image mask LCD of the operating microscope apparatusaccording to the eighth embodiment;

[0113]FIG. 38A is a plan view showing an outline of a drive mechanismfor a microscopic image mask LCD of an operating microscope apparatusaccording to a ninth embodiment of the invention;

[0114]FIG. 38B is a plan view showing an outline of a drive mechanismfor a microscopic image mask LCD of an operating microscope apparatusaccording to a tenth embodiment of the invention;

[0115]FIG. 39 is a general schematic view of an operating microscopeapparatus according to an eleventh embodiment of the invention;

[0116]FIG. 40A is a plan view showing a microscopic image in anoperating microscope apparatus according to the eleventh embodiment;

[0117]FIG. 40B is a perspective view showing an index/in-field displaycontroller;

[0118]FIG. 41A is a plan view showing a state in which a microscopicimage mask as large as an in-field display image is displayed on amicroscopic image mask LCD of the operating microscope apparatusaccording to the eleventh embodiment;

[0119]FIG. 41B is a plan view showing a state in which an index and amarker are displayed on the in-field display image;

[0120]FIG. 42A is a plan view showing a microscopic image in theoperating microscope apparatus according to the eleventh embodiment;

[0121]FIG. 42B is a plan view showing a state in which an index and amarker are displayed on the microscopic image by superposition;

[0122]FIG. 43 is a view schematically showing an outline of an operatingmicroscope and an endoscopic apparatus according to a twelfthembodiment;

[0123]FIG. 44 is a schematic view showing an endoscopic system alongwith a scope holder for supporting an endoscope shown in FIG. 43;

[0124]FIG. 45 is a view showing an outline of a binocular tube of theoperating microscope of FIG. 43;

[0125]FIG. 46 is a view showing an observational state of the operatingmicroscope for the case where an endoscopic image is mainly observed asa surgical operation is carried out;

[0126]FIG. 47 is a view similar to FIG. 46, showing an observationalstate of the operating microscope for the case where the observationalposition of the endoscope is moved;

[0127]FIG. 48 is a view similar to FIG. 43, schematically showing anoutline of an operating microscope and an endoscopic system according toa thirteenth embodiment;

[0128]FIG. 49 is a view showing an outline of a binocular tube of theoperating microscope of FIG. 48;

[0129]FIGS. 50A and 50B are views individually showing states ofobservation through an eyepiece optical system of the binocular tubeshown in FIG. 49;

[0130]FIG. 51 is a view illustrating a binocular tube optical system ofan operating microscope according to a fourteenth embodiment;

[0131]FIG. 52 is a view showing an outline of a in-field displaycontroller of an operating microscope according to a fifteenthembodiment;

[0132]FIGS. 53A and 53B are views individually showing display states inthe field of an operating microscope according to a sixteenthembodiment;

[0133]FIG. 54 is a general view of a surgical system using a rigid scopein combination with an operating microscope according to a seventeenthembodiment;

[0134]FIG. 55 is a detailed sectional view showing the construction ofthe rigid scope shown in FIG. 54;

[0135]FIG. 56 is a general view of a surgical system using a rigid scopein combination with an operating microscope according to an eighteenthembodiment;

[0136]FIG. 57 is a detailed sectional view showing the construction ofthe rigid scope shown in FIG. 56;

[0137]FIG. 58 is a view showing the configuration of the upper surfaceportion of a coupling portion of the rigid scope shown in FIG. 54;

[0138]FIG. 59 is a general view of a surgical system using a rigid scopein combination with an operating microscope according to a ninthembodiment;

[0139]FIG. 60 is a detailed sectional view showing the construction ofthe rigid scope shown in FIG. 59;

[0140]FIG. 61 is a view taken in the direction of arrow X of FIG. 60;

[0141]FIG. 62 is a perspective view of an endoscopic surgical systemaccording to a twentieth embodiment of the invention;

[0142]FIG. 63 is a sectional view of an instrument constituting theendoscopic surgical system of FIG. 62;

[0143]FIG. 64 is a conceptual diagram for illustrating wire-typetransmission means of the instrument;

[0144]FIG. 65 is a perspective view showing a first operation mode ofthe endoscopic surgical system of FIG. 62;

[0145]FIG. 66 is a perspective view showing a second operation mode ofthe endoscopic surgical system of FIG. 62;

[0146]FIG. 67 is a perspective view showing a modification of theendoscopic surgical system of FIG. 62;

[0147]FIG. 68 is a perspective view of an endoscopic surgical systemaccording to a twenty-first embodiment of the invention;

[0148]FIG. 69 is a sectional view of an instrument connecting member ofthe endoscopic surgical system of FIG. 68;

[0149]FIG. 70 is a block diagram of an electric control system for theendoscopic surgical system of FIG. 68;

[0150]FIG. 71 is a perspective view of an endoscopic surgical systemaccording to a twenty-second embodiment of the invention;

[0151]FIGS. 72 and 73 are views showing a prior art endoscopic surgicalsystem;

[0152]FIG. 74 is a schematic view showing a configuration of theprincipal part of a conventional operating microscope apparatus; and

[0153]FIGS. 75A and 75B are plan views individually showing in-fieldimages displayed in operator and mate eyepiece units, respectively, ofan operating microscope of the conventional operating microscopeapparatus.

DETAILED DESCRIPTION OF THE INVENTION FIRST EMBODIMENT

[0154] A first embodiment of the present invention will now be describedin detail with reference to the accompanying drawings.

[0155]FIG. 1 shows an outline of an operating microscope for use asfirst observational means of a surgical observational system accordingto the present embodiment. FIG. 2 is a block diagram according to thepresent embodiment, and FIG. 3 shows a microscope body portion of theoperating microscope in detail. Further, FIGS. 4A, 4B, 5A and 5B showthe respective operations of first and second liquid crystal shutters,and FIGS. 6A and 6B individually show images observed by an operator.FIGS. 7A and 7B show an example of a display image on monitors 40 and14.

[0156] The surgical observational system according to the firstembodiment will be described first.

[0157] The operating microscope of the surgical observational systemaccording to the present embodiment is provided with a stand 21, whichincludes a base 21 a movable on a floor surface and a support post 21 bset up on the base 21 a. One end of a first arm 22, which has a lightsource for illumination (not shown) therein, is mounted on the upper endportion of the post 21 b so as to be rotatable around an axis Oa.

[0158] One end of a second arm 23 is attached to the other end of thefirst arm 22, which is distant from the support post 21 b, so as to berotatable around an axis Ob. The second arm 23 is a pantograph arm thatis formed of a link mechanism and a balancing gas spring. The other endof the arm 23 that is off the first arm 22 can be moved vertically. Athird arm 24 is attached to the other end of the second arm 23 so as tobe rotatable around an axis Oc. Further, the third arm 24 is providedwith a swing arm 25 that enables a microscope body 1 to swing in theanteroposterior direction along the direction of the operator'sobservation around an axis Od and swing in the lateral direction of theoperator's body around an axis Oe. The microscope body 1, anobservational portion 2, and a handle 26 are mounted on the distal endportion of the arm 25.

[0159] In order to allow the microscope body 1 to be freely positionedin a three-dimensional space, moreover, each of the individual rockingportions that are rotatable around the axes Oa to Oe is provided with aelectromagnetic brake. Each rocking portion can be locked and unlockedby means of a switch (not shown) that is provided on the handle 26.Preferably, a power source unit for the electromagnetic brakes should beincorporated in the support post 21 b.

[0160] As shown in FIG. 2, the microscope body 1 is situated over anaffected region P which is a portion or an area to be operated, and anindex 3 for optical position detection is attached to a predeterminedface of the microscope body 1. The index 3 is fitted with a plurality ofinfrared LED's of the time-sharing emission type, which will not bedescribed in detail.

[0161] Although the microscope body 1 has therein two observationaloptical systems for supplying luminous fluxes individually to the twoeyes of the operator, only one of them will be described for simplicity.

[0162] As shown in FIG. 3, an observational optical system 10 iscomposed of an objective lens 4, first imaging lens 6, lens 7, secondimaging lens 8, and eyepiece 9, which are arranged successively from theside of the affected region P. A half-mirror 11 is interposed betweenthe lenses 7 and 8 of the optical system 10. The half-mirror 11 isoriented so that it can reflect a luminous flux from a directionperpendicular to the optical axis of the observational optical system 10toward the eyepiece 9. A projection optical system 15 is composed of alens 12, third imaging lens 13, and monitor 14, which are arrangedsuccessively on an optical axis that extends at right angles to theoptical axis of the optical system 10.

[0163] Further, a first liquid crystal shutter 16 is located on theimaging point of the first imaging lens 6 of the observational opticalsystem 10, and a second liquid crystal shutter 17 on the imaging pointof the third imaging lens 13 of the projection optical system 15.

[0164] As previously described with reference to FIG. 2, the microscopebody 1 is fitted with the index 3 for optical position detection. Anoptical position detecting member 30 (hereinafter referred to asdigitizer 30) is provided in a required position in an operating roomwhere it can shoot the index 3.

[0165] The digitizer 30 includes a plurality of infrared cameras, whichare mounted at given spaces. The digitizer 30 is connected to a positiondetector 31. The detector 31 is connected to a computing unit 32, whichis connected with a mixer 33 and a liquid crystal driver 34. Further,the unit 32 is connected with input means 35 and a footswitch 36. Theswitch 36 is provided with an image on-off switch (not shown).

[0166] As shown in FIG. 3, the liquid crystal driver 34 is connected tothe first and second liquid crystal shutters 16 and 17 in the microscopebody 1. The mixer 33 is connected to the monitor 14 in the microscopebody 1.

[0167] In FIG. 2, numeral 37 denotes an ultrasonic probe that isinserted in the affected region P. The probe 37 is fitted with an index38 that resembles the one on the microscope body 1. The index 38 is alsofitted with a plurality of infrared LED'S of the time-sharing emissiontype, which will not be described in detail. However, the time-sharingemission patterns of the infrared LED's that are attached to the index38 are different from those of the ones attached to the index 3. Theposition detector 31 can detect the respective positions of the patternsseparately.

[0168] The ultrasonic probe 37 is connected to an ultrasonic observer39. A video output (not shown) from the observer 39 is connected to themonitor 40 and the mixer 33.

[0169] Referring now to FIGS. 1 to 7B, there will be described theoperation of the surgical observational system according to the firstembodiment.

[0170] A luminous flux emitted from the light source (not shown) in thefirst arm 22 is applied to the affected region P of a patient's bodythrough an optical fiber (not shown) and an illumination optical system(not shown). As shown in FIG. 3, the luminous flux reflected by theaffected region P lands on the objective lens 4 of the microscope body1, is focused through the first imaging lens 6, first liquid crystalshutter 16, lens 7, half-mirror 11, and second imaging lens 8, and issubjected to enlarged-scale observation through the eyepiece 9 by theoperator. In this state, the whole surface of the first liquid crystalshutter 16 is transmittable, as shown in FIG. 4A. FIG. 6A shows theimage that is observed by the operator in this state. This process willbe mentioned later.

[0171] On the other hand, the ultrasonic probe 37 to be inserted intothe affected region P may be formed of a conventional ultrasonic probethat emits an ultrasound from a rotating portion (not shown) on itsdistal end. The ultrasound reflected by the affected region P isreceived by a sensor (not shown), and a signal from the sensor istransmitted to the ultrasonic observer 39. The observer 39 analyzes thesignal from the ultrasonic probe 37 and generates an image-processedvideo signal that is indicative of the internal structure of the tissuein accordance with the attenuation or phase of the ultrasound based onthe rotational angle of the rotating portion (not shown). Then, thevideo signal is delivered to the monitor 40 to be displayed thereon.FIG. 7A shows the image then displayed on the monitor 40. The same videosignal that is delivered to the monitor 40 is also delivered to themixer 33.

[0172] Further, the index 3 that is attached to the microscope body 1causes the infrared LED's (not shown) to glow in a given time-sharingpattern. Likewise, the index 38 that is attached to the ultrasonic probe37 causes the infrared LED's (not shown) to glow in a time-sharingpattern different from the pattern for the index 3.

[0173] The respective states of light emission of the indexes 3 and 38are-shot by means of the infrared cameras (not shown) of the digitizer30. The information obtained by means of the digitizer 30 is analyzed bymeans of the position detector 31, whereupon the respective positionsand attitudes of the microscope body 1 and the ultrasonic probe 37 inthe three-dimensional space are detected. A conventional suitabletechnique can be used for this optical position detection system.

[0174] Since the affected region P is also positioned in thethree-dimensional space, moreover, the position detector 31 can detectthe relative positions of the affected region P, microscope body 1(observational position of the operating microscope), and ultrasonicprobe 37 (plane for ultrasonic observation).

[0175] As shown in FIG. 2, the position information detected by means ofthe position detector 31 is delivered to the computing unit 32.

[0176] If the image on-off switch (not shown) of the footswitch 36 isthen off, the computing unit 32 delivers an image-off signal to themixer 33 and the liquid crystal driver 34. The mixer 33 outputs no imagewhen it receives the image-off signal from the computing unit 32.Therefore, no image is displayed on the monitor 14 that is connected tothe mixer 33. On receiving the image-off signal from the computing unit32, moreover, the liquid crystal driver 34 delivers given outputs to thefirst and second liquid crystal shutters 16 and 17. Thereupon, the wholesurface of the first liquid crystal shutter 16 becomes transmittable, asshown in FIG. 4A. Further, the second liquid crystal shutter 17 isrendered entirely interceptive, as shown in FIG. 5A. Thus, the operatorcan obtain no image from the monitor 1, only observing the optical imageof the affected region P. FIG. 6A shows this state of observation.

[0177] If the operator then turns on the image on-off switch of thefootswitch 36, an image-on signal is delivered to the computing unit 32.In this state, the computing unit 32 computes the position of the distalend of the ultrasonic probe 37 in the field of observation of theoperating microscope on the basis of the detected information from theposition detector 31. Further, the respective positions of the monitor14 and the first and second liquid crystal shutters 16 and 17corresponding to the distal end position are computed.

[0178] Then, the computing unit 32 calculates a signal from the inputmeans 35 and settles the size of an image in the microscopic field. Theoperator can freely change the image size by operating the input means35.

[0179] Based on the result of the aforesaid computation and the signalfrom the input means 35, the computing unit 32 delivers a control signalto the mixer 33. The mixer 33 converts the output image of theultrasonic observer 39 into an image that has its center in a positioncorresponding to the distal end position of the ultrasonic probe 37 ofthe monitor 14, and further generates an image signal of a reduced sizeset by means of the input means 35. FIG. 7B shows this image signal.

[0180] Then, the computing unit 32 delivers a control signal to theliquid crystal driver 34. The driver 34 generates, on the first andsecond liquid crystal shutters 16 and 17, a shielding portion 41 (firstliquid crystal shutter 16) and a transparent portion 42 (second liquidcrystal shutter 17) that have positions and sizes corresponding to therange of the reduced image that is generated by means of the mixer 33.This state is shown in FIG. 4B (for the first liquid crystal shutter 16)and FIG. 5B (for the second liquid crystal shutter 17).

[0181] In this arrangement, only that portion of the opticalobservational image from the objective lens 4 which corresponds to theshielding portion 41 is intercepted by means of the first liquid crystalshutter 16, and only the reduced image portion of the monitor 14 istransmitted to the side of the half-mirror 11 through the transparentportion 42 of the second liquid crystal shutter 17.

[0182] Thus, the operator can observe superposed ultrasonic images onthe monitor 14 in a predetermined range centering around the distal endof the ultrasonic probe 37, among other microscopic images. If theoperator moves the probe 37 within the microscopic field, the ultrasonicimages also move correspondingly in the field. FIG. 6B shows this stateof observation.

[0183] If the operator operates again the image on-off switch (notshown) of the footswitch 36, the ultrasonic images disappear in amoment, and the state of observation shown in FIG. 6A is restored.

[0184] Thus, the surgical observational system according to the firstembodiment can produce the following effects.

[0185] According to the first embodiment, the operator can observe theoptical observational image and ultrasonic diagnostic images in asuperposed manner, and the optical observational image is superposedonly partially. Therefore, the diagnostic images and the affected regioncan be easily correlated, and transfer to each treatment can be effectedsmoothly. Since the images follow the ultrasonic probe, moreover, theoperator can observe a desired region without delay. In consequence, theoperation time can be shortened, and the operator's fatigue can beeased.

SECOND EMBODIMENT

[0186] A second embodiment of the present invention will now bedescribed with reference to FIGS. 8 to 10C. In these drawings, likereference numerals refer to the same portions of the first embodiment,and a description of those portions is omitted.

[0187]FIG. 8 is a block diagram according to the present embodiment,FIG. 9 shows the body of the operating microscope in detail, and FIGS.10A to 10C individually show varied states of images the operatorobserves.

[0188] A surgical observational system according to the secondembodiment will be described first.

[0189] In the second embodiment, as shown in FIG. 9, a variable-scaleoptical system 50 is interposed between an objective lens 4 and a firstimaging lens 6 of a microscope body 1. A lens drive section (not shown)of the optical system 50 is provided with a sensor (not shown), which isconnected to magnification detecting means 56. As shown in FIG. 8, thedetecting means 56 is connected to a computing unit 55.

[0190] A changeover switch (not shown) of a footswitch 57, which isconnected to the computing unit 55, is connected to a position detector54. As in the case of the first embodiment, the output of a digitizer 30is connected to the position detector 54. The position detector 54includes an image forming section (not shown), the image output of whichis connected to a monitor 53 in the microscope body 1. A fourth imaginglens 52 and a mirror 51 are arranged successively on the emission sideof the monitor 53. The imaging position of the fourth imaging lens 52 issubstantially aligned with the reflective surface of the mirror 51 andthe imaging plane of a second imaging lens 8. Accordingly, the operatorcan simultaneously observe, through an eyepiece 9, a microscopic opticalimage formed by means of the first imaging lens 6 and an image on themonitor 53 formed by means of the fourth imaging lens 52.

[0191] The following is a description of the operation of the surgicalobservational system according to the second embodiment.

[0192] As in the case of the first embodiment, the position detector 54can detect the respective positions of the point of microscopeobservation and the distal end of an ultrasonic probe 37 relative to theaffected region P. Further, the detector 54 stores preoperativediagnostic images (e.g., slice images of an X-ray CT apparatus;normally, slice images in a given direction and a three-dimensional CGimage constructed by joining the slice images) in its storage section(not shown). In starting observation of the ultrasonic images in themicroscopic field, the operator turns on an image on-off switch (notshown) of the footswitch 57. As this is done, a signal from the sensor(not shown) of the variable-scale optical system 50 is transmitted tothe magnification detecting means 56. The detecting means 56 calculatesthe observation magnification of the microscope and delivers it to thecomputing unit 55.

[0193] Based on data from the magnification detecting means 56, thecomputing unit 55 sets the display size of an ultrasonic image to beprojected in the microscopic field. FIG. 10A shows the state of theimage the operator then observes.

[0194] If the operator operates the changeover switch (not shown) of thefootswitch 57 in this state, moreover, the position detector 54 reads apreoperative diagnostic slice image corresponding to the position of thedistal end portion of the ultrasonic probe 37 from the storage section(not shown). Then, the detector 54 superposes a marker on a region wherethe ultrasonic probe 37 is situated, and delivers the resulting image tothe monitor 53. As this is done, the mirror 51 moves from an evacuationposition (not shown) to an observational position shown in FIG. 9,whereupon the operator can observe the image on the monitor 53 alongwith a microscopic image through the mirror 51.

[0195] When the operator depresses the changeover switch (not shown)once, a preoperative diagnostic slice image, such as the one shown inFIG. 10B, is displayed. In this state, the operator can observe theactual affected region and the ultrasonic diagnostic image inassociation with the preoperative diagnostic slice image (with thedisplay of the ultrasonic probe position).

[0196] If the operator depresses the changeover switch once again, theposition detector 54 reads the three-dimensional image of the affectedregion P from the storage section (not shown), and carries out rotationprocessing (image processing) of the three-dimensional image so that theimage is aligned with the direction of actual insertion of theultrasonic probe 37 into the affected region. Then, the detector 54superposes the marker on the region and along the direction in which theprobe 37 is situated, and delivers the resulting image to the monitor53. FIG. 10C shows the image the operator then observes. In this state,the operator can observe the actual affected region and the ultrasonicdiagnostic image in association with the three-dimensional preoperativediagnostic image (with the display of the ultrasonic probe position anddirection).

[0197] If the operator depresses the changeover switch once again, themirror 51 moves to the aforesaid evacuation position (not shown),whereupon the operator can observes the image shown in FIG. 10A.

[0198] The surgical observational system according to the secondembodiment can produce the following effects.

[0199] According to the second embodiment, which enjoys the same effectsof the first embodiment, the display size of the ultrasonic image can beset automatically according to the observation magnification of theoperating microscope. Therefore, the operator can be saved the troubleof setting the image size, so that the efficiency of surgical operationscan be improved. Further, the operator can observe the preoperativediagnostic image simultaneously with the optical observational image andultrasonic diagnostic image. Accordingly, the approximate position ofthe whole patient's body in the position for ultrasonic observation canbe recognized with ease. Besides, the deviation between the actualaffected region and the preoperative diagnostic image, which isattributable to change of the intracranial pressure after craniotomy orexclusion of tissue, can be recognized easily. Thus, accurate surgicaloperations can be carried out, and the results of operations can beimproved.

[0200] Although the ultrasonic diagnostic image is displayedsubstantially in a circular form on the monitor 14 according to thesecond embodiment, its shape may be changed in the following manner.

[0201] In the case of an ultrasonic probe of the same radial-scan type(in which the periphery of the probe is scanned in a circle) as in theforegoing embodiment, as shown in FIG. 11A, the central portion of theultrasonic probe 37 may be extracted by means of the mixer 33 as it isdisplayed. The range of extraction is restricted to a radius that rangesfrom the distal end of the ultrasonic probe to the inner wall of thetissue of the affected region that is located closest to the probe. Thisrange can be settled by analyzing the ultrasonic image or by means of anoptical position detector. FIG. 11B shows an actual image then observedby the operator.

[0202] According to this arrangement, a microscopic optical image isdisplayed in a range without any object of diagnosis, extending from theultrasonic probe to the inner wall of the tissue of the affected region,and the region to be diagnosed can be displayed securely. Accordingly,the diagnosis can be carried out in the same manner as in the secondembodiment, and the distal end of the ultrasonic probe never fails to berecognized on the optical observational image. Thus, the operator canmove the ultrasonic probe without switching off the display of theultrasonic image, so that the efficiency of surgical operations can beimproved.

THIRD EMBODIMENT

[0203] A third embodiment of the present invention will now be describedwith reference to FIGS. 12 to 15D. In these drawings, like referencenumerals refer to the same portions of the first and second embodiments,and a description of those portions is omitted.

[0204]FIG. 12 is a general block diagram illustrating the presentembodiment, and FIG. 13 shows an observational image of a rigid scopefor use as second observational means according to the presentembodiment. FIGS. 14A to 14F illustrate the respective operations offirst and second liquid crystal shutters according to the presentembodiment, and FIGS. 15A to 15D show images observed by the operatoraccording to the present embodiment.

[0205] A surgical observational system according to the third embodimentwill be described first.

[0206] Numeral 1 denotes a body of an operating microscope thatresembles the one according to the first embodiment. The microscope body1, like the one according to the first embodiment, is fitted with anindex 3. As in the case of the second embodiment, a variable-scaleoptical system (not shown) of the microscope body 1 is provided with asensor (not shown), which is connected to magnification detecting means56. As in the cases of the first and second embodiments, moreover, themicroscope body 1 is provided with first and second liquid crystalshutters (not shown), which are connected to a liquid crystal driver 34.The microscope body 1 is provided with a monitor (not shown) thatresembles the one according to the first embodiment. The monitor isconnected to a mixer 33. Thus, the optical system in the microscope body1 of the present embodiment is constructed substantially in the samemanner as the one according to the first embodiment.

[0207] Numeral 90 denotes a 90°-squint rigid scope for use as secondobservational means according to the present embodiment. The rigid scope90 is connected with one end of a light guide 91, the other end of whichis connected to a light source 92. The rigid scope 90 is fitted with acamera head 93 for picking up its observational image. The camera head93 is connected to a camera control unit 94 (hereinafter referred tosimply as CCU 94). A first video output section (not shown) of the CCU94 is connected to a monitor 95. A second video output section (notshown) of the CCU 94 is connected to the mixer 33. Further, an index 96for position detection is attached to given position on the camera head93.

[0208] A digitizer 30 is located in a position such that it can shootboth the indexes 3 and 96 that are attached to the microscope body 1 andthe camera head 93, respectively. The digitizer 30 is connected to aposition detector 31. The detector 31 is connected to a computing unit97. Further, the magnification detecting means 56 and a footswitch 81are connected to the computing unit 97.

[0209] Furthermore, the computing unit 97 is connected to the mixer 33and the liquid crystal driver 34.

[0210] The following is a description of the operation of the thirdembodiment.

[0211] As in the case of the first embodiment, the operator subjects theaffected region P to enlarged-scale stereoscopic optical observation byusing the microscope body 1. Further, the operator uses the rigid scope90 to observe outside portions as viewed through the microscope body 1for the optical observation. More specifically, a luminous flux forobservation emitted from the light source 92 is landed on the lightguide 91. The light guide 91 transmits the incident luminous flux to therigid scope 90 that is connected to the other end thereof. This luminousflux is applied to the affected region P through an illumination opticalsystem (not shown) in the rigid scope 90. The luminous flux reflected bythe affected region P is landed on an objective lens (not shown) of therigid scope 90 and focused on an image-pickup device (not shown) of thecamera head 93 that is connected to the rear end of the scope 90. Thecamera head 93 converts the luminous flux, focused on the image-pickupdevice, into an electrical signal, and delivers it to the CCU 94. TheCCU 94 converts the electrical signal into a standardized video signal,and delivers it through its first and second video output sections (notshown).

[0212] Thus, the image shot by means of the rigid scope 90 is displayedon the monitor 95 that is connected to the first video output section ofthe CCU 94, as shown in FIG. 13. The same video signal is delivered fromthe second video output section of the CCU 94 to the mixer 33 in likemanner.

[0213] Infrared cameras (not shown) of the digitizer 30 are used toshoot infrared LED's (not shown) of the indexes 3 and 96 that areattached to the microscope body 1 and the camera head 93 of the rigidscope 90, respectively. As in the case of the first embodiment, theinformation obtained by means of the digitizer 30 is analyzed by meansof the position detector 31, whereupon the respective positions andattitudes of the microscope body 1 and the rigid scope 90 in thethree-dimensional space are detected. Since the affected region P isalso positioned in the three-dimensional space, moreover, the positiondetector 31 can detect the position of the affected region P relativelyto the respective observational positions and directions of themicroscope body 1 and the rigid scope 90.

[0214] The position information detected by means of the positiondetector 31 is delivered to the computing unit 97.

[0215]FIG. 15A shows an image then observed by the operator. Theoperator observes only an optical image that is obtained by means of thebody 1 of the operating microscope. In this state, the first liquidcrystal shutter (not shown) in the microscope body 1 is fullytransmittable, while the second liquid crystal shutter (not shown) isentirely interceptive. An image then obtained by means of the rigidscope 90 is displayed on the monitor 95.

[0216] In starting observation of the image obtained by means of therigid scope 90 in the microscopic field, the operator turns on an imageon-off switch (not shown) of the footswitch 81. The resulting signal istransmitted to the computing unit 97. On receiving an image-on signalfrom the footswitch 81, the computing unit 97 first carries outcomputation to display the image in a given position in the microscopicfield (upper left portion of the microscopic field according to thepresent embodiment) and delivers command signals to the liquid crystaldriver 34 and the mixer 33. More specifically, a signal is delivered tothe liquid crystal driver 34 such that it controls the first and secondliquid crystal shutters for the states shown in FIGS. 14A and 14B,respectively. Further, a signal is delivered to the mixer 33 such thatthe video signal from the CCU 94 is reduced at a suitable scale factorcomputed on the basis of a signal from the magnification detecting means56 and that the image is moved to a region corresponding to a shieldingportion of the second liquid crystal shutter and displayed on themonitor (not shown) in the microscope body 1 in the manner shown in FIG.14C. FIG. 15B shows the state of the image then observed by theoperator. In this state, the operator roughly positions the rigid scope90 while comparing the distal end of the rigid scope 90 and the affectedregion.

[0217] Then, in displaying the microscopic field and the field of therigid scope 90 in association with each other, the operator turns on animage shift switch (not shown) of the footswitch 81. The resultingsignal is applied to the computing unit 97. On receiving this signal,the computing unit 97 computes the position of display of the image ofthe rigid scope 90 in the microscopic field in accordance with positioninformation from the position detector 31 and magnification informationon the microscope body 1 from the magnification detecting means 56.Thus, the range of the microscopic field is calculated from the positionand magnification of the body 1 of the microscope, while the distal endposition and observational direction of the rigid scope 90 in themicroscopic field is calculated from the position information of thescope 90. Based on the results of these calculations, the computing unit97 delivers a command signal to display the image of the rigid scope 90in a circular range that has its center on the observational-directionside of the rigid scope 90 with its distal end on a point on thediameter of the circle. More specifically, the first and second liquidcrystal shutters are set for the states shown in FIGS. 14D and 14E,respectively, and the monitor (not shown) in the microscope body 1displays the image shown in FIG. 14F. Thus, the operator can obtain thefield shown in FIG. 15B in the microscopic field.

[0218] Since the rigid scope 90 is 90°-squint, moreover, theobservational direction changes if it is rotated for 90° in its axialdirection, for example. In this state also, the image of the rigid scope90 is displayed in a circular range that has its center on theobservational-direction side of the rigid scope 90 with its distal endon a point on the diameter of the circle, so that the field shown inFIG. 15D can be obtained.

[0219] According to this third embodiment, the second observationalmeans, e.g., the rigid scope or an ultrasonic observation apparatus ofthe front-scan type, can be effectively used in particular when anobject is observed in a given direction from the distal end of theprobe, and the observational image is displayed in the observationaldirection of the probe. Accordingly, the observational direction andposition of the second observational means can be grasped with ease, andbesides, the optical image of the actual affected region and the imageobtained by means of the second observational means are positioned inassociation with each other as they are displayed. Thus, the state ofthe affected region can be grasped quickly and accurately.

[0220] Although the second observational means has been described asmeans for observing a narrower range than the operating microscope orfirst observational means does, in connection with the second and thirdembodiments, the present invention is not limited to this arrangement.If an image of a wide range that includes the affected region isobtained by means of an X-ray CT apparatus or the like, for example, apart of the image may be cut out and projected in the microscopic fieldin like manner provided that the positional relations between the image,the actual affected region, and the position of the body of themicroscope can be grasped. According to each of the foregoingembodiments, the image is displayed following the distal end of eachprobe. In the case of a wide-range image such as the aforesaid X-ray CTimage, however, a cursor may be displayed in the microscopic field sothat the operator can move it by means of the footswitch or the like,thereby causing the cut image to follow the cursor. Thus, the operatorcan observe only a desired portion of the X-ray CT image to be referredto, in association with the affected region, so that the effects of thepresent invention can be accomplished.

[0221] Although the operating microscope is used as the firstobservational means and the image of the second observational means issuperposed on the microscopic optical image according to the first tothird embodiments, the present invention is not limited to thisarrangement. It is to be understood that quite the same effects can beproduced if the display image of the first observational means is a TVmonitor.

FOURTH EMBODIMENT

[0222] A fourth embodiment of the present invention will now bedescribed. The following is a description of a configuration of afluorescent image observation apparatus of an operating microscope withposition detecting means that can detect the position of an affectedregion.

[0223]FIG. 16 shows a configuration of the operating microscope with theposition detecting means that can detect the affected region position.This configuration will be briefly described herein, since it isdescribed in Jpn. Pat. Appln. No. 10-319190 filed by the assignee of thepresent invention. Numeral 101 denotes the operating microscope, whichcomprises a microscope body 102 that constitutes an observationaloptical system through which an operator 108 can observe an affectedregion of a patient 107. The microscope body 102 is provided with anemissive index 103.

[0224] Numeral 104 denotes a digitizer 104, which includes two CCDcameras 105 a and 105 b for use as receivers and a camera support member106 for supporting these cameras. The digitizer 104 serves as opticalposition detecting means that uses the CCD cameras 105 a and 105 b todetect the emissive index 103 of the microscope body 102, therebydetecting the observational position of the microscope.

[0225]FIG. 17 shows a configuration of an illumination system of theoperating microscope 101, and FIG. 18 shows a configuration of theobservational optical system of the microscope 101. FIG. 17 is a diagramas viewed from a position A of FIG. 18.

[0226] The illumination system shown in FIG. 17 comprises a light source109, condensing lens 110, illumination lens 112, and beam splitter 113.The members 110, 112 and 113 serve to guide illumination light emittedfrom the light source 109 to the affected region P of the patient 107.

[0227] An illumination light switching filter 111 includes anillumination light transmitting filter 111 a for transmittingillumination light for the affected region P, an excitation lighttransmitting filter 111 b for transmitting only excitation light that isinductive to fluorescence, and a drive motor 111 c for use as aswitching mechanism for changing these two filters. Thus, the filter 111serves as illumination light switching means for the affected region P.Further, an objective lens 114, zoom optical systems 115L and 115R, andbeam splitters 116L and 116R are provided for the observation of lightreflected by the affected region P.

[0228] The observational optical system shown in FIG. 18 comprises thebeam splitters 116L and 116R and eyepieces 117L and 117R, as well as thezoom optical systems 115L and 115R. An image from the affected region Pis transmitted through the beam splitter 116L to a lens 118L, a mirror120L, and an image-pickup device 121L, which constitute a shootingsystem.

[0229] An observational light switching filter 119L includes anillumination light transmitting filter 119L1 for transmitting theillumination light for the affected region P, a cutoff filter 119L2 forcutting off the excitation light and illumination light, and a drivemotor 119L3 for use as a switching mechanism for changing these twofilters. Thus, the filter 119L serves as observational light switchingmeans for the affected region P.

[0230]FIG. 19 is a general functional block diagram of the operatingmicroscope 101. In FIG. 19, the motors 111 c and 119L3 are connected toa filter drive controller 123, which can control these motorssimultaneously, in response to a signal from an input switch (displaymode setting means) 122 for fluorescent image observation. The filterdrive controller 123 serves to control the motors 111 c and 119L3 sothat the illumination light transmitting filter 111 a of theillumination light switching filter 111 and the illumination lighttransmitting filter 119L1 of the observational light switching filter119L are simultaneously situated on the optical axis. The controller 123also serves to control the motors 111 c and 119L3 so that the excitationlight transmitting filter 111 b of the illumination light switchingfilter 111 and the cutoff filter 119L2 of the observational lightswitching filter 119L are simultaneously situated on the optical axis.Under this control, the operation mode can be changed from a fixed-timefluorescent observation mode to a normal (visible zone) observation modeby means of a timer circuit (not shown).

[0231] Further, the image-pickup device 121L is connected to a videosignal processor 128. The device 121L is composed of a drive processorcircuit (not shown) and a video signal generator circuit (not shown). Amemory (storage means) 129, which can operate in response to a signalfrom the input switch 122, is composed of an image memory and a binarycoder circuit (not shown) for binary-coding a video signal deliveredfrom the video signal processor 128.

[0232] Furthermore, a workstation (hereinafter referred to as WS) 125 isconnected with a microscope body controller 126, digitizer 124, monitor127, and mixer 130. The controller 126 can detect and transmitinformation data such as the magnification, focal length, etc. of theoperating microscope 101 that is provided with the emissive index 103.The digitizer 124 can detect the position of the affected region P bydetecting the index 103. If the magnification and focus information dataare changed, they are transmitted from the controller 126 to the WS 125.Thereupon, the WS 125 selects a preoperative image corresponding to theoperating position in consideration of the transmitted data and positioninformation from the digitizer 124. The digitizer 124 and the WS 125constitute position computing means.

[0233] The mixer 130, which is connected to the WS 125, video signalprocessor 128, and memory 129, serves to superpose video signals thatare transmitted individually from the WS 125, processor 128, and memory129, and can display the superposed video signals on a monitor 131outside the microscope body. The mixer 130 and the monitor 131constitute display means.

[0234] In the arrangement described above, the observational position ofthe operating microscope is detected by detecting the emissive index 103on the microscope by means of the digitizer 124 and computing thepositional relation between the microscope and the detected index 103 bymeans of the WS 125. By doing this, the correlation with atwo-dimensional preoperative tomographic image as a diagnostic image ofthe patient's body stored in the WS 125 can be obtained (the apparatusof this type is called a navigation apparatus).

[0235]FIG. 20 is a flowchart for illustrating the operation of thepresent invention. Since a method for simultaneously shooting the imagebased on the illumination light and the fluorescent image is describedin detail in Jpn. Pat. Appln. KOKAI Publication No. 9-24052, onlyfeatures of the present invention will be described in the following.

[0236] If the input switch 122 for fluorescent image observation isturned on (A1), the filter drive controller 123 controls the motors 111c and 119L3 (A2-1) to locate the excitation light transmitting filter111 b of the illumination light switching filter 111 and the cutofffilter 119L2 of the observational light switching filter 119Lsimultaneously on the optical axis.

[0237] Fluorescent shooting (A3-1) is carried out in this state. Lighttransmitted through the excitation light transmitting filter 111 b ofthe illumination light switching filter 111 is applied to the affectedregion P, thereby inducing fluorescence. The illumination light and theexcitation light is cut off by means of the cutoff filter 119L2 of theobservational light switching filter 119L, and only the detectedfluorescent image induced by the affected region P is reflected by themirror 120L and landed on the image-pickup device 121L.

[0238] The detected fluorescent image incident upon the image-pickupdevice 121L is converted into a video signal by means of the videosignal processor 128 and applied to the memory 129 and the mixer 130.The video signal that is applied to the memory 129 is binary-coded (A4).Thereafter, it is applied to the mixer 130 and displayed as afluorescent observational image on the monitor 131.

[0239] If the motors 111 c and 119L3 are controlled by means of thefilter drive controller 123 so that the illumination light transmittingfilter 111 a of the illumination light switching filter 111 and theillumination light transmitting filter 119L1 of the observational lightswitching filter 119L are located simultaneously on the optical axis,the illumination light is applied to the affected region P, and an imageof the affected region is landed on the image-pickup device 121L. Thisillumination light is processed by means of the video signal processor128 and applied to the mixer 130.

[0240] As this is done, a two-dimensional preoperative image thatmatches the observational position information (A2-2) on the affectedregion P obtained according to the emissive index 103, which is detectedby means of the digitizer 124, and the magnification and focusinformation data on the operating microscope 101, which are transmittedfrom the microscope body controller 126 to the WS 125, is selected fromones that are previously recorded in the WS 125 (A3-2) and applied tothe mixer 130.

[0241] The mixer 130 synthesizes (superposes) the video image based onthe illumination light form the video signal processor 128, thefluorescent image binary-coded by means of the memory 129, and thepreoperative image selected and inputted by means of the WS 125 (A5).

[0242] In these circumstances, the filter drive controller 123 selectsthe illumination light transmitting filter 111 a and the illuminationlight transmitting filter 119L1 on illumination and shooting lightpaths, respectively. The image-pickup device 121L shoots an image in anormal or visible zone. A tumor position obtained by the aforesaidfluorescent observation and a tumor position based on thetwo-dimensional preoperative tomographic image selected by means of theWS 125 are superposed on the image of the affected region presentlyobtained by the operator and are displayed on the monitor 131.

[0243]FIG. 21 is a diagram for illustrating the way of synthesizing thefluorescent observational image and the two-dimensional preoperativetomographic image.

[0244] In an entire tumor image 142 as an affected region in an entirehead image 141 of FIG. 21, a plane image (fluorescent observationalimage) 145 a, based on a fluorescent image obtained from a certaincurved surface in a surgical treatment position (exposed tumor portion144), and a two-dimensional preoperative tomographic image 145 b,selected as a microscopic observational position by the WS 125, can besynthesized and displayed on the monitor 131.

[0245] If the operator then moves the focal center position from B to Cby focusing operation, the center of observation (center of the depth offocus) can be detected by means of the digitizer 124 and the WS 125 sothat a corresponding tomographic image can be selected and synthesizedwith the aforesaid fluorescent observational image. In terminating thefluorescent observation, the operator is expected to turn off the inputswitch 122, thereby switching off the superposed display.

[0246] The fourth embodiment described above enjoys the followingeffects. Since an actual affected region has no flat surface, display ofonly a tomographic image as a diagnostic image in the microscopicobservational position can hardly cover the state of the affectedregion. With use of the arrangement of the present embodiment, however,tomographic images based on the focusing operation for the presenttreatment position are superposed on the fluorescent observational imageas they are displayed, so that the progress of a surgical operation andthe conditions of a tumor can be recognized visually.

[0247] Further, the fluorescent observational image is superposed on thetwo-dimensional preoperative tomographic image as it is displayed. Ifthe surgical operation is advanced according to the preoperativetomographic image, therefore, the operator can recognize supplementarycorrection of the position according to the fluorescent observationalimage during the operation. Thus, the correction is easy.

[0248] Since the mode for the superposed observation can be set by theinput switch operation, moreover, the superposed observation can beselectively carried out as required. If only the external shape of thetumor portion is expected to be emphasized in the tomographic image fromthe WS, the operator can easily discriminate it by making its displaycolor different from that of the fluorescent observational image.

FIFTH EMBODIMENT

[0249]FIGS. 22 and 23 show a configuration according to a fifthembodiment. Since left- and right-hand observational images of anaffected region are processed in the same manner, the way of processingthe left-hand observational image will now be describedrepresentatively.

[0250] As in the case of the fourth embodiment, illumination orexcitation light is applied to the affected region, and an image of theaffected region is obtained by means of an image-pickup device 121L. Thedevice 121L is connected to a video signal processor 135L for convertingan image into a video signal. An output signal from the processor 135Lis applied to a left-hand memory 136L. The memory 136L serves tobinary-code the image, and its signal is applied to a left-hand mixer137L that can superpose a plurality of video images. Output signals fromthe left-hand mixer 137L and a right-hand mixer 137R are applied to a 3Dconverter 139 to be converted into a three-dimensional video imagethereby, whereupon the video image can be displayed on a 3D monitor 140.

[0251] Further, output signals from the left-hand video signal processor135L and a right-hand video signal processor 135R are applied to the 3Dconverter 139 to be converted into a three-dimensional video imagethereby, and the image can be displayed on the 3D monitor 140.

[0252] The WS 125 can apply the three-dimensional video image tobilateral screen dividing means 138, which can divide thethree-dimensional video image into images with a lateral parallax. Aleft-hand video image is generated and applied to the left-hand mixer137L. The mixer 137L is connected to a left-hand monitor 134L. Further,a lens 133L and a beam splitter 132L are arranged in order to guide thevideo image on the monitor 134L to the eyepiece 117L (see FIG. 22).

[0253] With the arrangement described above, fluorescence is excited,and the resulting fluorescent image is delivered to left- and right-handimage-pickup devices 121L and 121R, as in the case of the fourthembodiment. Since video images applied to the image-pickup devices 121Land 121R are processed in the same manner, only the processing on theleft-hand side will now be described. The fluorescent image obtained bymeans of the image-pickup device 121L is applied to the left-hand videosignal processor 135L to be converted into a video signal thereby, andapplied to the left-hand memory 136L and the 3D converter 139.

[0254] In order to divide stereoscopic image information, based on thepreoperative tomographic image information recorded in the WS 125, intoimages with a lateral parallax, moreover, the preoperative tomographicimage is applied to the bilateral screen dividing means 138. In theleft-hand mixer 137L, a left-hand image produced by the dividing means138 is superposed on the signal from the left-hand memory 136L thatbinary-codes the signal from the left-hand video signal processor 135L.

[0255] A synthetic image delivered from the left-hand mixer 137L isapplied to the 3D converter 139 and the left-hand monitor 134L. Theconverter 139 can convert the video image from the left- and right-handmixers 137L and 137R into a three-dimensional image and display theimage on the 3D monitor 140.

[0256] The light applied to the left-hand monitor 134L is guided to theeyepiece 117L via the lens 133L and the beam splitter 132L.

[0257] In this manner, the observational image of the affected region Pbased on the illumination light, the fluorescent observational imagebased on the application of the excitation light to the affected region,and the three-dimensional image based on the preoperative image can besimultaneously cast into the operator's field of vision and displayed onthe 3D monitor 140. In this case, the present treated sectioninformation based on the fluorescent observational image is superposedthree-dimensionally on a three-dimensional exterior view of a tumor(three-dimensional tumor image 147), such as the one shown in FIG. 25,so that the present progress of operation for the whole tumor can berecognized. In FIG. 25, the outline is formed by a position detectingfunction, and broken lines represent a stereoscopic affected regionimage based on the fluorescent observational image.

[0258] According to the fifth embodiment described above, the opticalobservational images obtained by microscopic observation are superposed,so that the present treatment position and progress of the affectedregion P in the whole tumor can be grasped three-dimensionally, and thedirection of the treatment to be advanced thereafter can be recognizedaccurately. Dislocation of the preoperative tomographic image from theentire external shape can be also recognized, and it can be minutelycorrected by stereoscopic observation. Thus, an environment can beprovided for high-safety surgical operations.

SIXTH EMBODIMENT

[0259] The following is a description of only differences of a sixthembodiment of the present invention from the fifth embodiment. FIG. 24is a diagram showing a configuration of the sixth embodiment. An imagesignal based on illumination light incident upon a left-hand videosignal processor 135L is applied to a left-hand mixer 137L. In the sixthembodiment, the mixer 137L is connected to a left-hand in-field displaycontroller 148L. The controller 148L is constructed in the same manneras an in-field display controller that constitutes an in-field displaydevice (in-field display controller and lens tube portion) describedwith reference to FIG. 1 in Jpn. Pat. Appln. No. 10-248672. According tothe sixth embodiment, the display according to the fifth embodiment isindicated and observed as an image display separate from the microscopicfield.

[0260] In the arrangement described above, the image signal based on theillumination light incident upon the left-hand video signal processor135L is applied to the left-hand mixer 137L. In the mixer 137L, amicroscopic image based on the illumination light, a fluorescent imagebased on excitation light, and a preoperative image selected accordingto the outer peripheral surface of an affected region are synthesizedand applied to the left-hand in-field display controller 148L. The videoimage applied to the controller 148L is displayed as an in-field displayimage by means of the in-field display device, and only an image basedon the illumination light is visible as the microscopic image.

[0261] The sixth embodiment described above has the following effects aswell as the effects of the fifth embodiments. In the microscopic imagebased on the illumination light, as shown in FIG. 26, an exposed tumorportion 151 that cannot be recognized by the operator can be identifiedby being compared with the superposed in-field display image. Further,the three-dimensional shape of a tumor and the position of an affectedregion in the whole tumor can be grasped without screening a microscopicimage 150 with the preoperative image and the fluorescent observationalimage.

SEVENTH EMBODIMENT

[0262] A seventh embodiment of the present invention will now bedescribed with reference to FIGS. 27 to 35B. FIG. 27 shows the generalexternal appearance of an operating microscope 201 of an operatingmicroscope apparatus according to the present embodiment. A stand 202 ofthe operating microscope 201 of the present embodiment is provided witha base 203 movable on a floor surface and a support post 204 set up onthe base 203.

[0263] Further, the support post 204 is provided, on its top portion,with a body 205 of the operating microscope 201, including an opticalsystem for observing an affected region, and a support mechanism 206 forsupporting the body 205 for movement in any desired direction. Themechanism 206 is a combination of a plurality of moving arms 207 forlocating the microscope body 205 in a desired position.

[0264] As shown in FIG. 28, moreover, the body 205 of the operatingmicroscope 201 of the present embodiment is provided with an operatoreyepiece unit 208 and a mate eyepiece unit 209. The body 205 is alsoprovided with a barre1 210 for rotatably holding the mate eyepiece unit209. The eyepiece unit 209 can be rotated with respect to the operatoreyepiece unit 208 by means of the barre1 210.

[0265] Located near the barre1 210, moreover, is a position detectingencoder 211 that detects the rotational angle of the mate eyepiece unit209 with respect to the operator eyepiece unit 208 and outputs it as anelectrical signal.

[0266]FIG. 29 is a schematic view of an optical system of the body 205of the operating microscope 201, and FIG. 30 is a block diagram of anelectric circuit of the microscope 201. As shown in FIG. 29, the opticalsystem of the body 205 of the operating microscope 201 according to thepresent embodiment is provided with a beam splitter 212 for dividing amicroscopic image (incident light) into two parts for an operator-sideoptical system La and a mate-side optical system Lb. The light incidentupon the beam splitter 212 is divided into two light beams, transmittedand reflected. The transmitted and reflected light beams, divided fromthe microscopic image by means of the beam splitter 212, are landed onthe operator- and mate-side optical systems La and Lb, respectively.

[0267] Further, the operator-side optical system La includes a mainimage display optical system La1 for displaying a main microscopic imageand an in-field display optical system La2 for projecting an index and asub-image, which is different from the main image, on a part of themicroscopic field. The main image display optical system La1 is providedwith an objective lens 213 a, LCD 214 a for microscopic image masking,total-reflection mirror 215 a, imaging lens 216 a, prism 217 a, andeyepiece 218 a. The LCD 214 a is located on a first imaging point 213 a1 of the objective lens 213 a.

[0268] The in-field display optical system La2 is provided with an LCD(in-field monitor) 219 a for in-field display, imaging lens 220 a, prism217 a, and eyepiece 218 a. The prism 217 a and the eyepiece 218 a areused in common in the main image display optical system La1 and thein-field display optical system La2. The microscopic image from the mainimage display optical system La1 and an in-field display image from thein-field display optical system La2 are superposed and landed on theside of the eyepiece 218 a by means of the prism 217 a.

[0269] Likewise, the mate-side optical system Lb includes a main imagedisplay optical system Lb1 for displaying a main microscopic image andan in-field display optical system Lb2 for projecting an index and asub-image, which is different from the main image, on a part of themicroscopic field. The main image display optical system Lb1 is providedwith an objective lens 213 b, LCD 214 b for microscopic image masking,total-reflection mirror 215 b, imaging lens 216 b, prism 217 b, andeyepiece 218 b. The LCD 214 b is located on a first imaging point 213 b1 of the objective lens 213 b.

[0270] The in-field display optical system Lb2 is provided with an LCD(in-field monitor) 219 b for in-field display, imaging lens 220 b, prism217 b, and eyepiece 218 b. The prism 217 b and the eyepiece 218 b areused in common in the main image display optical system Lb1 and thein-field display optical system Lb2. The microscopic image from the mainimage display optical system Lb1 and an in-field display image from thein-field display optical system Lb2 are superposed and landed on theside of the eyepiece 218 b by means of the prism 217 b.

[0271] In the operating microscope 201 according to the presentembodiment, an endoscopic image from an endoscope 221 shown in FIG. 30is displayed on the respective LCD's 219 a and 219 b for in-fielddisplay of the operator- and mate-side optical systems La and Lb. A TVcamera head 222 is coupled to the endoscope 221. A CCTV unit 223 isconnected to the camera head 222. The endoscopic image of the endoscope221 is picked up by means of the camera head 222, and the resultingoptical video image is photoelectrically converted by means of animage-pickup device (not shown) in the camera head 222. Thereafter, theimage is applied as an electrical signal to the CCTV unit 223 andprocessed, whereupon a TV signal is outputted.

[0272] As shown in FIG. 30, moreover, an electric circuit block of theoperating microscope 201 according to the present embodiment is providedwith an operator-side processing system Ka and a mate-side processingsystem Kb. The CCTV unit 223 is connected with an in-field imagegenerator circuit 224 a of the operator-side processing system Ka and anin-field image generator circuit 224 b of the mate-side processingsystem Kb.

[0273] The operator-side processing system Ka is provided with a firstLCD driver 225 a for driving the LCD 214 a for microscopic imagemasking, a second LCD driver 226 a for driving the LCD 219 a forin-field display, a display changing circuit 227 a, the in-field imagegenerator circuit 224 a, and a microscopic image masking processor 228a. Further, the in-field image generator circuit 224 a and themicroscopic image masking processor 228 a are connected with an in-fielddisplay controller (input means) 229 for inputting observationconditions in which the size, position, etc. of images to be displayedon the LCD's 219 a and 219 b for in-field display are changed.

[0274] Furthermore, the in-field image generator circuit 224 a and themicroscopic image masking processor 228 a are connected to the inputside of the display changing circuit 227 a. The first and second LCDdrivers 225 a and 226 a are connected to the output side of the circuit227 a.

[0275] The output of the CCTV unit 223 is applied to the in-field imagegenerator circuit 224 a of the operator-side processing system Ka, theoutput of which is applied to the display changing circuit 227 a. Anoutput signal from the microscopic image masking processor 228 a is alsoapplied to the circuit 227 a, the output of which is applied to the LCDdrivers 225 a and 226 a. Further, output signals from the LCD drivers225 a and 226 a are applied to the LCD 214 a for microscopic imagemasking and the LCD 219 a for in-field display, respectively.

[0276] The mate-side processing system Kb is provided with a third LCDdriver 225 b for driving the LCD 214 b for microscopic image masking, afourth LCD driver 226 b for driving the LCD 219 b for in-field display,a display changing circuit 227 b, the in-field image generator circuit224 b, and a microscopic image masking processor 228 a. Further, thein-field image generator circuit 224 b and the microscopic image maskingprocessor 228 b are connected with the in-field display controller 229.

[0277] In the mate-side processing system Kb according to the presentembodiment, moreover, a first rotation computing circuit (observationalstate changing means) 230 is interposed between the in-field imagegenerator circuit 224 b and the display changing circuit 227 b, while asecond rotation computing circuit (observational state changing means)231 is interposed between the microscopic image masking processor 228 band the display changing circuit 227 b.

[0278] The first and second rotation computing circuits 230 and 231 areconnected to the input side of the display changing circuit 227 b.Further, the third and fourth LCD drivers 225 b and 226 b are connectedto the output side of the circuit 227 b.

[0279] On the side of the mate-side processing system Kb, the output ofthe CCTV unit 223 is applied to the in-field image generator circuit 224b of the mate-side processing system Kb, the output of which is appliedto the display changing circuit 227 b via the first rotation computingcircuit 230. A signal from the microscopic image masking processor 228 bis also applied to the display changing circuit 227 b via the secondrotation computing circuit 231. The output of the circuit 227 b isapplied to the LCD drivers 225 b and 226 b. Further, output signals fromthe drivers 225 b and 226 b are applied to the LCD 214 b for microscopicimage masking and the LCD 219 b for in-field display, respectively.

[0280] The position detecting encoder 211 is connected to the first andsecond rotation computing circuits 230 and 231. An output signal fromthe encoder 211 is applied to the circuits 230 and 231, while thecontrol output of the in-field display controller 229 is applied to thein-field image generator circuits 224 a and 224 b and the microscopicimage masking processors 228 a and 228 b.

[0281] The following is a description of the function of the operatingmicroscope 201. In starting the operation of the operating microscope201 of the present embodiment, a microscopic image of an affected regionin an operative field j (see FIG. 74) as an object of surgical operationis divided into two parts for the operator- and mate-side opticalsystems La and Lb by means of the beam splitter 212. The divided imagefor the operator-side optical system La is focused on the first imagingpoint 213 a 1 of the objective lens 213 a, whereupon a microscopic image232 a for the optical system La is formed, as shown in FIG. 31A.Further, the image for the mate-side optical system Lb, divided by meansof the beam splitter 212, is focused on the first imaging point 213 b 1of the objective lens 213 b, whereupon a microscopic image 232 b for theoptical system Lb is formed, as shown in FIG. 31A.

[0282] In FIG. 30, the endoscopic image shot by means of the endoscope221 is picked up by means of the camera head 222. The resulting opticalvideo image is photoelectrically converted by means of the image-pickupdevice (not shown) in the camera head 222. Thereafter, the image isapplied as an electrical signal to the CCTV unit 223 and processed,whereupon a TV signal is outputted. The TV signal delivered from theCCTV unit 223 is applied to the respective in-field image generatorcircuits 224 a and 224 b of the operatorand mate-side processing systemKa and Kb.

[0283] The output signal processed in the in-field image generatorcircuit 224 a of the operator-side processing system Ka is applied tothe display changing circuit 227 a. As this is done, the output signalfrom the microscopic image masking processor 228 a is also applied tothe circuit 227 a. Further, the output signal from the circuit 227 a isapplied to the LCD drivers 225 a and 226 a. The control signals from theLCD drivers 225 a and 226 a are applied to the LCD 214 a for microscopicimage masking and the LCD 219 a for in-field display, respectively.

[0284] Since the LCD 214 a for microscopic image masking is located onthe first imaging point 213 a 1 of the objective lens 213 a, a maskportion 233 a for sub-image is inserted into a part of the microscopicimage 232 a for the operator-side optical system La by means of the LCD214 a, as shown in FIG. 31A. As this is done, moreover, an endoscopicimage 234 a is partially displayed on a part of the whole LCD screen ofthe LCD 219 a for in-field display, and the remaining part is left as ashielding portion 235 a, as shown in FIG. 31B.

[0285] The image of FIG. 31A that combines the microscopic image 232 aand the mask portion 233 a for sub-image inserted therein and the imageof FIG. 31B that combines the endoscopic image 234 a and the shieldingportion 235 a are superposed by means of the prism 217 a. Thereupon, acomposite image 238 a is formed having an endoscopic image (sub-image)237 a inserted in a microscopic image (main image) 236 a, as shown inFIG. 32A.

[0286] The same operation on the operator side is also carried out onthe mate side. More specifically, the output signal processed in thein-field image generator circuit 224 b of the mate-side processingsystem Kb is applied to the display changing circuit 227 b through thefirst rotation computing circuit 230. As this is done, the output signalfrom the microscopic image masking processor 228 b is also applied tothe circuit 227 b through the second rotation computing circuit 231.Further, the output signal from the circuit 227 b is applied to the LCDdrivers 225 b and 226 b. The output signals from the LCD drivers 225 band 226 b are applied to the LCD 214 a for microscopic image masking andthe LCD 219 a for in-field display, respectively.

[0287] Since the LCD 214 b for microscopic image masking is located onthe first imaging point 213 b 1 of the objective lens 213 b, a maskportion 233 b for sub-image is inserted into a part of the microscopicimage 232 b for the mate-side optical system Lb by means of the LCD 214b, as shown in FIG. 31A. As this is done, moreover, an endoscopic image234 b is partially displayed on a part of the whole LCD screen of theLCD 219 b for in-field display, and the remaining part is left as ashielding portion 235 b, as shown in FIG. 31B.

[0288] The image of FIG. 31A that combines the microscopic image 232 band the mask portion 233 b for sub-image inserted therein and the imageof FIG. 31B that combines the endoscopic image 234 b and the shieldingportion 235 b are superposed by means of the prism 217 b. Thereupon, acomposite image 238 b is formed having an endoscopic image (sub-image)237 b inserted in a microscopic image (main image) 236 b, as shown inFIG. 32A.

[0289] As the in-field display controller 229 is operated, theobservation conditions in which the size, position, etc. of the imagesto be displayed on the LCD's 219 a and 219 b for in-field display arechanged are inputted. Depending on the conditions inputted by means ofthe controller 229, the in-field image generator circuits 224 a and 224b output control signals for changing the size, position, etc. of theimages to be displayed on the LCD's 219 a and 219 b.

[0290] In the microscopic image masking processors 228 a and 228 b,moreover, the mask portions 233 a and 233 b are formed having the samesize and position as the endoscopic images 234 a and 234 b that aregenerated by means of the in-field image generator circuits 224 a and224 b, as shown in FIG. 31A. Thus, the mask portion 233 a of FIG. 31Aand the endoscopic image 234 a of FIG. 31B are equal in size.

[0291] According to the present embodiment, furthermore, two images arealternatively changed by means of the display changing circuit 227 a bythe operator's processing, and images are displayed individually on theLCD's 214 a and 219 a by means of the LCD drivers 225 a and 226 a. Inthe mate-side processing system, the images of FIGS. 31A and 31B,generated by means of the in-field image generator circuit 224 b and themicroscopic image masking processor 228 b, are subjected to mapconversion in the rotation computing circuits 230 and 231 in accordancewith the output of the position detecting encoder 211 that detects therotational angle of the mate eyepiece unit 209, and then rotated in themanner shown in FIGS. 31C and 31D. The images shown in FIGS. 31C and 31Dare obtained by rotating the images of FIGS. 31A and 31B, respectively,for 180°.

[0292] The mate-side image processed in this manner forms the compositeimage 238 b of FIG. 32B, which is an image obtained by rotating thecomposite image 238 a of FIG. 32A without changing the relativepositions of the microscopic images 236 a and 2326 b and the endoscopicimages 237 a and 237 b therein.

[0293] The following is a description of operation for the case wherepreoperative diagnostic images, such as X-ray CT's, are displayed on theLCD's 219 a and 219 b for in-field display of the operator- andmate-side optical systems La and Lb. According to the presentembodiment, computer images, such as X-ray CT's (not shown), are appliedto the in-field image generator circuits 224 a and 224 b of FIG. 30. Inthis case, the output of the circuit 224 b is applied directly to thedisplay changing circuit 227 b without actuating the rotation computingcircuits 230 and 231 of the mate-side processing system Kb. Inconsequence, composite images 240 a and 240 b are obtained includingcomputer images 239 a and 239 b inserted in the microscopic images 236 aand 2326 b, as shown in FIGS. 33A and 33B, respectively. FIGS. 33A and33B show the operator- and mate-use composite images 240 a and 240 b,respectively. The computer images 239 a and 239 b, which serve asin-field images in the microscopic images 236 a and 236 b, are common tothe operator- and mate-use composite images 240 a and 240 b, and aredisplayed in like manner in a fixed direction.

[0294]FIGS. 35A and 35B show states in which indexes (markers) 242 a and242 b are overlaid on microscopic images 241 a and 241 b, respectively.The microscopic images 241 a and 241 b are used on the operator side andon the mate side, respectively.

[0295] Further, FIG. 34A shows a mask image 243 a or 243 b overlain bythe index 242 a or 242 b, and FIG. 34B shows an in-field display image.In this case, the mask size for the mask image 243 a or 243 b is reducedto zero, so that the index 242 a or 242 b appears as the in-fielddisplay image. The microscopic images 241 a and 241 b obtained in thiscase have their corresponding indexes 242 a and 242 b superposedthereon, as shown in FIGS. 35A and 35B, respectively.

[0296] If the mask portion 233 a or 233 b is larger than the endoscopicimage 234 a or 234 b in FIGS. 31A to 31D, the endoscopic image 234 a or234 b in the field has a frame (not shown). If the mask portion 233 a or233 b is smaller than the endoscopic image 234 a or 234 b, on the otherhand, the periphery of the endoscopic image 234 a or 234 b in the fieldis blurred.

[0297] In the case where the endoscopic image 234 a or 234 b in thefield of the microscopic image 232 a or 232 b represents a graphic form,such as a line or circle, the graphic form is replaced with themicroscopic image 232 a or 232 b if the mask portion 233 a or 233 b hasthe same shape as the in-field endoscopic image 234 a or 234 b. Overlaydisplay is made if the mask portion 233 a or 233 b need not be formed.

[0298] The arrangement described above produces the following effects.In the mate-side processing system Kb according to the presentembodiment, the first rotation computing circuit 230 is interposedbetween the in-field image generator circuit 224 b and the displaychanging circuit 227 b, while the second rotation computing circuit 231is interposed between the microscopic image masking processor 228 b andthe display changing circuit 227 b. Further, the position detectingencoder 211 for detecting the rotational angle of the mate eyepiece unit209 with respect to the operator eyepiece unit 208 is connected to thefirst and second rotation computing circuits 230 and 231. If the mateeyepiece unit 209 is rotated with respect to the operator eyepiece unit208 with the in-field image of an auxiliary optical system projectedinto the microscopic field so that the composite image 238 a or 238 b isformed including the endoscopic image 237 a or 237 b inserted in themicroscopic 236 a or 236 b, as shown in FIG. 32A, therefore, the imagesof FIGS. 31A and 31B that are generated by means of the in-field imagegenerator circuit 224 b and the microscopic image masking processor 228b of the mate-side processing system Kb are subjected to map conversionin the rotation computing circuits 230 and 231 in accordance with theoutput of the position detecting encoder 211 that detects the rotationalangle of the mate eyepiece unit 209, and then rotated in the mannershown in FIGS. 31C and 31D. Accordingly, the composite image 238 b ofFIG. 32B is displayed on the mate eyepiece unit 209 with the compositeimage 238 a of FIG. 32A displayed on the operator eyepiece unit 208. Ifthe mate eyepiece unit 209 is rotated with respect to the operatoreyepiece unit 208, therefore, a microscopic field of the same positionalrelations for the operator can be continuously secured for the mate.Thus, the in-field image of the auxiliary optical system produces nodead angles in the microscopic field.

[0299] If necessary, moreover, an image in the same direction as the oneon the operator side can be projected on the in-field image of theauxiliary optical system on the mate side by a simple method, or thein-field image can be displayed with a desired size and in a freeposition. Further, an index such as a marker overlaid on the microscopicimage, as well as the in-field image of the auxiliary optical system,can be realized by only the image processing without changing the systemconfiguration, so that a lot of types of display and observation methodscan be selected without entailing any troublesome manipulation duringthe surgical operation. In consequence, necessary in-field informationcan be properly offered to the operator or his or her mate, and theaimed microscopic field can be easily secured during the operation.

EIGHTH EMBODIMENT

[0300]FIGS. 36 and 37 show an eighth embodiment of the presentinvention. In the present embodiment, the configuration of the mateeyepiece unit 209 of the seventh embodiment is modified in the followingmanner.

[0301] According to the present embodiment, the rotation computingcircuits 230 and 231 in the mate-side processing system Kb of theseventh embodiment are omitted or replaced with an LCD rotatingmechanism 251 for rotating the LCD 214 b for microscopic image maskingand the LCD 219 b for in-field display in the mate-side optical systemLb.

[0302] As shown in FIG. 37, the LCD rotating mechanism 251 of thepresent embodiment comprises a ring-shaped first LCD driving gear 252,to which the LCD 214 b for microscopic image masking is fixed, and aring-shaped second LCD driving gear 253, to which the LCD 219 b forin-field display is fixed. The LCD 214 b for microscopic image maskingis fixed in the ring of the first LCD driving gear 252. Likewise, theLCD 219 b for in-field display is fixed in the ring of the second LCDdriving gear 253.

[0303] A gear 255 is fixed to the rotating shaft of a drive motor 254 ofthe LCD rotating mechanism 251. The gear 255 is in mesh with anintermediate gear 256 as well as with the second LCD driving gear 253.Further, the intermediate gear 256 is in mesh with the first LCD drivinggear 252. The gear ratio between the gears 255 and 256 is adjusted to1:1. Thus, the first and second LCD driving gears 252 and 253 can rotatein the same direction and at the same speed as the gear 255 rotates.

[0304] A motor control circuit 257 is connected to the drive motor 254.A position detecting encoder 211 is connected to the circuit 257. Anoutput signal from the encoder 211 is applied to the circuit 257,whereby the operation of the motor 254 is controlled.

[0305] The following is a description of the operation of the presentembodiment arranged in this manner. If a mate eyepiece unit 209 isrotated with respect to an operator eyepiece unit 208, according to thepresent embodiment, the output signal from the position detectingencoder 211, corresponding to the rotational angle of the mate eyepieceunit 209, is applied to the motor control circuit 257. Thus, the circuit257 controls the operation of the drive motor 254.

[0306] As this is done, the motor 254 causes the gear 255 to rotateaccording to the rotational angle of the mate eyepiece unit 209. Thesecond LCD driving gear 253 is rotated in association with the rotationof the gear 255, and the first LCD driving gear 252 is rotated throughthe medium of the intermediate gear 256. Since the gear ratio betweenthe gears 255 and 256 is adjusted to 1:1, the first and second LCDdriving gears 252 and 253 rotate in the same direction and at the samespeed. Accordingly, the positional relation between the LCD 219 b forin-field display and the LCD 214 b for microscopic image masking can bekept fixed, and image display equivalent to the one obtained by theimage rotation shown in FIGS. 31C and 31D can be realized.

[0307] According to the present embodiment, therefore, the output signalfrom the position detecting encoder 211 that detects the rotationalangle of the mate eyepiece unit 209 is applied to the motor controlcircuit 257, and the operation of the drive motor 254 is controlled bymeans of the circuit 257. Thus, if the mate eyepiece unit 209 is rotatedwith respect to the operator eyepiece unit 208, according to the presentembodiment, the LCD rotating mechanism 251 is driven according to therotational angle α the mate eyepiece unit 209 by means of the motor 254,so that the LCD 214 b for microscopic image masking and the LCD 219 bfor in-field display in the mate-side optical system Lb can be rotatedindividually. According to the present embodiment, therefore, a lot oftypes of display and observation methods can be selected withoutentailing any troublesome manipulation during the surgical operation, asin the case of the first embodiment, and besides, the in-field image canbe offered without lowering the image quality during image computationfor the image rotating process.

NINTH EMBODIMENT

[0308]FIG. 38A shows a ninth embodiment of the present invention. In thepresent embodiment, the LCD rotating mechanism 251 of the eighthembodiment is modified in the following manner.

[0309] The LCD rotating mechanism 251 of the eighth embodiment isdesigned so that the LCD 214 b for microscopic image masking and the LCD219 b for in-field display in the mate-side optical system Lb arerotated individually by means of the gear mechanism. However, thepresent embodiment is provided with an LCD rotating mechanism 261 thatis formed of a belt drive mechanism.

[0310] The LCD rotating mechanism 261 of the present embodimentcomprises a first LCD driving pulley 262, to which the LCD 214 b formicroscopic image masking is fixed, and a second LCD driving pulley 263,to which the LCD 219 b for in-field display is fixed.

[0311] A pulley 264 is fixed to the rotating shaft of a drive motor (notshown) of the LCD rotating mechanism 261. Further, an endless belt 265is passed around and between the pulley 264 and the first and second LCDdriving pulleys 262 and 263. The driving pulleys 262 and 263 are equalin diameter. Thus, the first and second LCD driving pulleys 262 and 263can rotate in the same direction and at the same speed.

[0312] As in the case of the eighth embodiment, moreover, the motorcontrol circuit 257 (see FIG. 36) is connected to the drive motor forthe pulley 264. The position detecting encoder 211 is connected to thecircuit 257. An output signal from the encoder 211 is applied to thecircuit 257, whereby the operation of the drive motor is controlled.

[0313] The following is a description of the operation of the presentembodiment arranged in this manner. If a mate eyepiece unit 209 isrotated with respect to an operator eyepiece unit 208, according to thepresent embodiment, the output signal from the position detectingencoder 211, corresponding to the rotational angle of the mate eyepieceunit 209, is applied to the motor control circuit 257. Thus, the circuit257 controls the operation of the drive motor.

[0314] As this is done, the motor causes the pulley 264 to rotateaccording to the rotational angle of the mate eyepiece unit 209, and thefirst and second LCD driving pulleys 262 and 263 are rotated in the samedirection and at the same speed by means of the belt 265. Accordingly,the positional relation between the LCD 219 b for in-field display andthe LCD 214 b for microscopic image masking can be kept fixed, and imagedisplay equivalent to the one obtained by the image rotation shown inFIGS. 31C and 31D can be realized. Thus, the present embodiment canprovide the same effects of the second embodiment.

TENTH EMBODIMENT

[0315]FIG. 38B shows a tenth embodiment of the present invention. In thepresent embodiment, the respective configurations of the operator- andmate-side LCD's 214 a and 214 b for microscopic image masking of theseventh embodiment are modified in the following manner.

[0316] As shown in FIG. 38B, the present embodiment is provided with asupport frame 272 that has a circular window 271. The window 271 of theframe 272 is located on the first imaging point 213 a 1of the objectivelens 213 a.

[0317] A shielding plate 273 is movably supported on the support frame272 so as to cover a part of the circular window 271. Further, racks 274are formed individually on the opposite sides of the shielding plate273. The racks 275 are in mesh with driving gears 275, individually. Thegears 275 are fixed to the rotating shaft of a motor 276. As the gears275 rotate, the shielding plate 273 is advanced or retreated so as tocover a part of the window 271 of the frame 272.

[0318] The following is a description of the operation of the presentembodiment arranged in this manner. According to the present embodiment,the drive of the motor 276 is controlled by means of a control signaldelivered from in-field display range setting means (not shown). As themotor 276 rotates, the gear 275 rotates. In association with therotation of the gear 275, the shielding plate 273 moves in the directionof the arrow in FIG. 38B, whereupon the area of the part of the circularwindow 271 that is covered by the support frame 272 is changed. Thus,the microscopic image masking area is changed.

[0319] The arrangement described above also fulfills the same functionsof the operator- and mate-side LCD's 214 a and 214 b for microscopicimage masking of the seventh embodiment. Thus, the present embodimentcan provide the same effects of the seventh embodiment.

ELEVENTH EMBODIMENT

[0320] FIGS. 39 to 42B show an eleventh embodiment of the presentinvention. FIG. 39 shows an outline of the whole system of an operatingmicroscope apparatus 281 according to the present embodiment.

[0321] The operating microscope apparatus 281 of the present embodimentcomprises an operating microscope 282 constructed substantially in thesame manner as the operating microscope 201 of the seventh embodiment,index/in-field display controller 283, position information computingmeans 284, and position detecting means 285 for detecting the positionof the operating microscope 282.

[0322] A stand 286 of the operating microscope 282 of the presentembodiment is provided with a base 287 movable on a floor surface and asupport post 288 set up on the base 287.

[0323] Further, the support post 288 is provided, on its top portion,with a body 289 of the operating microscope 282, including an opticalsystem for observing an affected region, and a support mechanism 290 forsupporting the body 289 for movement in any desired direction. Themechanism 290 is a combination of a plurality of moving arms 291 forlocating the microscope body 289 in a desired position.

[0324] Furthermore, the microscope 282 is connected with theindex/in-field display controller 283, position information computingmeans 284, and position detecting means 285. The microscope 282 issupplied with an index/in-field display control signal 292 from thecontroller 283 and a position information computing means image signal293 and an arm driving signal 294 from the computing means 284.

[0325]FIG. 40B is an exterior view of the index/in-field displaycontroller 283. A body 295 of the controller 283 is provided with ajoystick 296 and two switches 297 and 298. An index control signal 283 ais delivered from the controller 283 to the position informationcomputing means 284.

[0326]FIG. 40A shows a microscopic image 299 of the operating microscope282. A position information computing means image 300 and a marker 301are displayed in the field of the microscopic image 299. Two indexes 302a and 302 b are displayed in the image 300.

[0327] The following is a description of the operation of the presentembodiment. According to the present embodiment, the microscope 282 issupplied with the position information computing means image signal 293from the position information computing means 284. The image signal 293is displayed as an in-field display image 304 on an LCD 303 for in-fielddisplay, as shown in FIG. 41B. A preoperative image, such as an X-rayCT, is displayed in the in-field display image 304. Further, the indexes302 a and 302 b are displayed in the image 304, while the marker 301 isdisplayed on the LCD 303.

[0328] A microscopic image mask 306, which is as large as the in-fielddisplay image 304, is displayed on an LCD 305 for microscopic imagemasking shown in FIG. 41A. A microscopic image 308 shown in FIG. 42B issuperposed on a microscopic image 307 shown in FIG. 42A.

[0329] Referring to FIG. 40A, the index 302 a in the positioninformation computing means image 300, an MIR or X-ray CT diagnosticimage, and the marker 301 in the field of the microscopic image 299 arepointed in the same direction in the operative field.

[0330] The joystick 296 and switches 297 and 298 of the controller 283of FIG. 40B are operated to transmit the index control signal 283 a tothe position information computing means 284. Based on this information,the control means 284 transmits the image, moved to the indexes 302 aand 302 b, as shown in FIG. 40A, to the microscope 282 in response tothe position information computing means image signal 293, and displaysthe image in the in-field display image 304 of the microscope 282.

[0331] Further, the position information computing means 284 controlsthe support mechanism 290 of the microscope 282 in response to the armdriving signal 294, thereby moving the microscope body 289 so that theindex 302 b and the marker 301 are situated in the same position in theoperative field.

[0332] According to the present embodiment arranged in this manner, theoperator can designate his or her desired view point on a positioninformation computing means image, and the observational position can beautomatically moved to the point. Thus, the field of vision can beeasily moved to a target region during the surgical operation.

TWELFTH EMBODIMENT

[0333] FIGS. 43 to 47 show a twelfth embodiment of the presentinvention.

[0334]FIG. 43 shows an outline of an operating microscope apparatus 401and an endoscopic apparatus according to the present embodiment. Themicroscopic apparatus 401 of the present embodiment is supported on astand 402. The stand 402 is provided with a base 402 a movable on afloor surface and a support post 402 b set up on the base 402 a. Amoving arm mechanism 404 for movably supporting a microscope body 403 ofthe microscopic apparatus 401 is provided on the top portion of thesupport post 402 b. The mechanism 404 is formed of a plurality of movingarms including first, second, and third arms 405, 406 and 407 and aswing arm 408.

[0335] One end of the first arm 405 is mounted on the upper end portionof the support post 402 b for rocking motion around an axis Oa. Thefirst arm 405 has an illumination light source (not shown) therein. Oneend of the second arm 406 is mounted on the other end of the first arm405 for rocking motion around an axis Ob.

[0336] The second arm 406 is a pantograph arm that is formed of a linkmechanism and a balancing spring member, whereby the microscope body 403can be moved in the vertical direction. The third arm 407 is mounted onthe other end of the second arm 406 for rocking motion around an axisOc.

[0337] The proximal end portion of the swing arm 408 is coupled to thethird arm 407. The microscope body 403, a binocular tube 409 forstereoscopic observation, and a handle 410 are provided on the distalend portion of the arm 408. The swing arm 408 is supported forlongitudinal swinging motion such that it causes the microscope body 403to rock in the longitudinal direction around an axis Od, which extendsat right angles to the drawing plane of FIG. 43, with respect to thedirection of the operator's observation, and for transverse swingingmotion such that it causes the microscope body 403 to rock in thetransverse direction of the operator around an Oe.

[0338] Further, electromagnetic brakes (not shown) are providedindividually on rocking portions corresponding to the axes Oa to Oe ofthe moving arm mechanism 404, whereby the position of the microscopebody 403 can be freely spatially adjusted and fixed. These brakes aredesigned so that their locking or free state can be freely selected byoperating a switch (not shown) on the handle 410. Preferably, a lightsource unit (not shown) for the moving arm mechanism 404 should beincorporated in the support post 402 b of the stand 402, for example.

[0339] The binocular tube 409 of the microscope body 403 is formedhaving left- and right-hand observational optical paths for stereoscopicobservation. Each of the observational optical paths of the lens tube409 is provided with an objective lens (not shown) and a variable-scaleoptical system (not shown). Numeral 440 denotes an endoscopic system forobserving dead angles of the operating microscope.

[0340] As shown in FIG. 44, the endoscopic system 440 comp a rigid scope441 having an observation port axis Og at a given angle to the directionof insertion, a TV camera 442 including a TV camera head 442 a forpicking up an observational image of the scope 441 and a TV controller442 b, and a monitor 443 connected to the controller 442 b anddisplaying the observational image of the scope 441. The rigid scope 441is fixed to a bedside stay 445 by means of a scope holder 444.

[0341] The scope holder 444 is provided with a fixing portion 446 fixedto the bedside stay 445, vertical arm 447, moving arms 448 a and 448 b,slanting arm 449, and holding portion 450, which are connected to oneanother in the order named. The arms 447, 448 a, 448 b and 449 and theholding portion 450 are rotatable around axes Op, Og, Or, Os and Ot,respectively. Electromagnetic brakes 451 a to 451 e are providedindividually at portions corresponding to these axes of rotation,whereby the position of the rigid scope 441 can be freelythree-dimensionally adjusted and fixed.

[0342] These electromagnetic brakes are designed so that their lockingor free state can be selected by operating a switch 452 on the holdingportion 450. The switch 450 and the brakes 451 a to 451 e are connectedto a holder control section 453. The control section 453 is providedwith a driver circuit (not shown), which outputs driving signals fordisengagement to the brakes 451 a to 451 e while an operating signalfrom the switch 452 is being inputted, and a circuit that delivers theinput signal from the switch 452 to an in-field display controller 454(mentioned later).

[0343]FIG. 45 shows an outline of the binocular tube 409 according tothe present embodiment. The lens tube 409 is provided with a right-eyeobservational optical system 411 shown in FIG. 45 and a left-eyeobservational optical system (not shown). FIG. 45 shows a part of theright-eye optical system 411, viewed from the lateral of the lens tube409. Since the left-eye observational optical system is constructed inthe same manner as the optical system 411 shown in FIG. 45, thefollowing is a description of the optical system 411 only.

[0344] The right-eye optical system 411 according to the presentembodiment comprises a binocular tube optical system (firstobservational optical system) 412 for observing the observational imageof the operating microscope and an image projection optical system(second observational optical system) 413 for observing optional imageinformation that is different from the observational image. Thebinocular tube optical system 412 is provided with an imaging opticalsystem 414, image rotator 415, parallelogrammatic prism 416, andeyepiece optical system 417. The observational image of the operatingmicroscope, incident upon the binocular tube optical system 412, isguided from the imaging optical system 414 to the eyepiece opticalsystem 417 via the image rotator 415 and the prism 416 in succession.

[0345] Further, the image projection optical system 413 is provided withan LCD display 420 as an in-field display function, collimating opticalsystem 421, variable-scale optical system 422 having a variableprojection magnification, imaging optical system 423, and movable prism424. The prism 424, which is oriented in the direction of arrow S withinthe plane of a reflective surface 424 a, is movable with respect to theimage projection optical system 413 by means of a motor 425 a. On theother hand, the variable-scale optical system 422 is connected so thatits magnification can be changed by driving a motor 425 b.

[0346] The movable prism 424 and the variable-scale optical system 422are driven in a relation such that the image on the LCD display 420 isenlarged in proportion to the depth of insertion of the prism 424 in thebinocular tube optical system 412 as it is projected by means of theoptical system 422.

[0347] The image information displayed on the LCD display 420 is guidedto the eyepiece optical system 417 successively through the collimatingoptical system 421, variable-scale optical system 422, imaging opticalsystem 423, and movable prism 424. The eyepiece optical system 417ensures simultaneous observation of the observational image of theoperating microscope transmitted through the binocular tube opticalsystem 412 and the optional image information transmitted through theimage projection optical system 413.

[0348] Numeral 454 denotes the in-field display controller (displayformat changing means), which is connected to the holder control section453 to which the switch 452 of the scope holder 444 is connected, LCDdisplay 420, TV controller 442 b, and motors 425 a and 425 b. Thecontroller 454 is composed of driver circuits for the motor 425 a formoving the prism 424 and the motor 425 b for driving the variable-scaleoptical system 422, control circuits for controlling the drive of thedriver circuits, and a display control circuit that is supplied with avideo signal from the TV controller 442 b of the TV camera 442 anddisplays an image on the LCD display 420.

[0349] The observational image of the operating microscope apparatus 401ensures stereoscopic observation of an affected region through themicroscope body 403 by means of the binocular tube optical system 412 ofthe binocular tube 409. As this is done, the movable prism 424 of theimage projection optical system 413 is on the optical path of thebinocular tube optical system 412, as shown in FIG. 45. The image of theaffected region observed through the rigid scope 441 is picked up bymeans of the TV camera head 442 a shown in FIG. 44. This image isdisplayed on the monitor 443 and the LCD display 420 by means of the TVcontroller 442 b and the in-field display controller 454 shown in FIG.45, respectively. The display image is observed through the imageprojection optical system 413 and the eyepiece optical system 417.

[0350]FIG. 46 shows a state of observation for the case where the imageof the rigid scope is mainly observed as the surgical operation iscarried out. In FIG. 46, numerals 455 and 456 denote a microscopic imageand an image observed through the rigid scope 441, respectively. Therigid scope 441 itself is displayed in the microscopic image 455.

[0351] On the other hand, the operator can change the observationalposition of the rigid scope 441 by depressing the switch 452 of thescope holder 444 to disengage the electromagnetic brakes 451 a to 451 f.By doing this, the rigid scope 441 can be freely moved in athree-dimensional manner. As this is done, the holder control section453 disengages the electromagnetic brakes 451 a to 451 b to cancel thelocked state, and delivers an ON-signal of the switch 452 to thein-field display controller 454.

[0352] On receiving this input signal, the in-field display controller454 drives the motors 425 a and 425 b to a previously stored specifiedextent, and the depth of insertion of the movable prism 424 in thebinocular tube optical system is reduced. At the same time, themagnification of the variable-scale optical system 422 is changed into(or lowered to) a value that is settled properly for the movement of themovable prism 424. Thereupon, the image observed through the eyepieceoptical system 417 looks like the one shown in FIG. 47. Thus, the image456 of the rigid scope, compared to the microscopic image 455, moves toan end of the field of vision, and is displayed in a contracted form.

[0353] In this manner, the image 456 of the rigid scope 441, compared tothe observational image 455 of the operating microscope, is observed ina wide range in the case where the observational position of the scope441 is fixed, and in a narrow range if the observational position of thescope 441 is changed (or if the scope 441 is moved). When no normalrigid scope observation is carried out, a footswitch (not shown) of themicroscope can be operated entirely to remove the movable prism 424 fromthe optical path of the binocular tube optical system 412 with ease.Thus, observation can be effected in the same manner as the observationby means of the conventional operating microscope.

[0354] The rigid scope image 456 is displayed wide on the observationalimage 455 of the operating microscope when it is used for a requiredtreatment or observation, so that the treatment operation is easy. Sincethe display of the rigid scope image 456 is small while the rigid scope441 is being moved, on the other hand, the state of insertion of therigid scope 441 in the microscopic image 455 can be observedsatisfactorily.

[0355] According to the present embodiment, the operating state of therigid scope 441 is detected by detecting the disengagement of the scopeholder 444 for holding the scope 441, so that the surgical operation canbe smoothly carried out without requiring use of any special device fordetection and its operation.

[0356] Further, the movement of the rigid scope 441 can be detected moreeasily than by using an optical position detector according to athirteenth embodiment described below.

THIRTEENTH EMBODIMENT

[0357] FIGS. 48 to 50B show a thirteenth embodiment.

[0358] As is schematically shown in FIG. 48, an operating microscopeapparatus 401 and an endoscopic system 440 according to the presentembodiment are constructed in the same manner as the ones according tothe twelfth embodiment, so that a detailed description of those elementsis omitted. The following is a description of the optical positiondetector for the operating microscope apparatus 401 and the endoscopicsystem 440. This optical position detector may be a conventional one.

[0359] As shown in FIG. 48, emissive indexes 460 and 461 are attached tothe operating microscope apparatus 401 and the endoscopic system 440,respectively. The indexes 460 and 461 can be shot by means of anilluminant image-pickup device 462 that is provided with image-pickupmeans. The device 462 is connected with a position detecting section 463for computing the position and angle of an illuminant in response to asignal from the device 462. The position detecting section 463 iscomposed of a position data computing section for a microscope body 403,a position data computing section for a rigid scope 441, and a positioncalculating section for calculating the position of the rigid scope 441relative to the position of the microscope body 403. The detectingsection 463 delivers information on the observational direction of therigid scope with respect to the microscope body 403 to an in-fielddisplay controller 464, which will be mentioned later.

[0360]FIG. 49 shows an outline of a binocular tube 465 according to thepresent embodiment.

[0361] A binocular tube optical system 412 of the binocular tube 465 isconstructed in the same manner as the one according to the twelfthembodiment. Therefore, a description of the system 412 is omitted, andthe following is a description of an arrangement of an image projectionoptical system 469, a unique element.

[0362] The image projection optical system 469 comprises an LCD display420 for use as an in-field display function, collimating optical system466, imaging optical system 467, and prism 468. Image informationdisplayed on the LCD display 420 is guided to an eyepiece optical system417 successively through the collimating optical system 466, imagingoptical system 467, and prism 468.

[0363] The image projection optical system 469, which is incorporated ina chassis 470, is connected so that it can be rocked integrally with thechassis 470 around an optical axis Of of the eyepiece optical system 417of the binocular tube 465 by means of a motor 471. The eyepiece opticalsystem 417 ensures simultaneous observation of the observational imageof the operating microscope transmitted through the binocular tubeoptical system 412 and optional image information transmitted throughthe image projection optical system 469.

[0364] The in-field display controller 464 is connected to the positiondetecting section 463 of the aforesaid optical position detector, a TVcontroller 442 b, the LCD display 420, and the chassis rotating motor471. The controller 464 is composed of a driver circuit for the chassisrotating motor 471, control circuit for controlling the drive of thedriver circuit, display control circuit for the LCD display 420, controlcircuit for controlling the rotation of the motor 471 in response to aposition signal from the position detecting section 463, and a displaycontrol circuit that is supplied with a video signal from the TV camera442 and displays an image on the LCD display 420.

[0365] The observational image of the operating microscope apparatusaccording to the thirteenth embodiment ensures stereoscopic observationof an affected region through the microscope body 403 by means of thebinocular tube optical system 412 of the binocular tube 465. As this isdone, the movable prism 468 of the image projection optical system 469is on the optical path of the binocular tube optical system 412, asshown in FIG. 49. The image of the affected region observed through therigid scope 441 is picked up by means of a TV camera head 442 a. Thisimage is displayed on a monitor 443 and the LCD display 420 by means ofthe TV controller 442 b and the in-field display controller 464,respectively. The display image on the display 420 is observed throughthe image projection optical system 469 and the eyepiece optical system417.

[0366] During a surgical operation, the respective positions of themicroscope body 403 and the rigid scope 441 are always detected by meansof a conventional optical position detector. The position detectingsection 463 obtains the direction (angle) of observation of the rigidscope 441 with respect to the observation direction of the microscopebody 403, and delivers angle information to the in-field displaycontroller 464. In response to this angle information, the controller464 rotates the motor 471 as required, thereby causing the imageprojection optical system 469 always to rotate integrally with thechassis in the same direction as the observation direction of the rigidscope. FIGS. 50A and 50B show states that are observed by means of theeyepiece optical system 417. In this case, an image of the rigid scope441 is displayed in the same direction as the observational direction(indicated by arrow B) of the scope 441.

[0367] According to the operating microscope 401 of the presentembodiment, the image 456 that is obtained through the rigid scope 441and displayed in the field of observation is displayed in the samedirection as the observational direction of the rigid scope, so that theoperator can intuitively recognize the observational direction of therigid scope 441. Thus, the operator can be intent on the surgicaloperation without suffering troublesomeness, and therefore, theoperation time can be shortened.

[0368] Since the optical position detecting means is used in the presentembodiment, moreover, the system is readily compatible with aconventional navigation system that displays the respectiveobservational positions of the surgical operation and the rigid scope441 on a diagnostic image.

[0369] According to the present embodiment, furthermore, the opticalposition detecting means is used to detect the observational directionof the rigid scope 441 with respect to the microscope body 403.Alternatively, however, the observational direction of the rigid scope441 can be easily detected by means of an encoder or the like that isattached to a joint portion of the scope holder of the twelfthembodiment and serves as rotational angle detecting means. In this case,a simple system can be enjoyed.

FOURTEENTH EMBODIMENT

[0370] A fourteenth embodiment will be described with reference to FIG.51. According to the present embodiment, the operating microscopeapparatus of the twelfth embodiment is modified so that the binoculartube is designed differently and its visibility is automaticallyadjusted to the operator's eyes.

[0371]FIG. 51 shows an outline of a binocular tube 480 according to thepresent embodiment. The binocular tube 480 is provided with a binoculartube optical system (first observational optical system) 412, which issimilar to the one according to the first embodiment, an imageprojection optical system 481 for observing optional image informationthat is different from an observational image, a measurement opticalsystem 487 for refractive index measurement, and a light receivingoptical system 488. The optical systems 481, 487 and 488 constitute asecond observational means. A detailed description of the binocular tubeoptical system 412, which is constructed in the same manner as the oneaccording to the twelfth embodiment, is omitted.

[0372] The image projection optical system 481 comprises an LCD display482 for use as in-field display means, collimating optical system 483,imaging optical system 484, and movable prism 485. A dichroic mirror 486is located on an optical path between the prism 485 and the imagingoptical system 484. The movable prism 485 is provided on the opticalpath in a manner such that it can be removed by means of a motor (notshown).

[0373] The measurement optical system 487 comprises the movable prism485, the dichroic mirror 486, a half-mirror 489, a slit plate 490 in aposition conjugate to the eyeground of a subject eye having a referencerefractive force, a diffuser panel 491, and a light emitting diode foremitting infrared light. Thus, the optical system 487 shares somecomponents with the image projection optical system 481.

[0374] The light receiving optical system 488 comprises the movableprism 485, the dichroic mirror 486, the half-mirror 489, a shieldingmember 494 in a position conjugate to the slit plate 490, and a lightreceiving element 495 in a position conjugate to the pupil. Thus, theoptical system 488 shares some components with the measurement opticalsystem 487. Numeral 496 denotes a measurement section for computing therefractive force of the subject eye according to the light quantitydistribution of the light receiving element 495. The measurement section496 is connected to a visibility correction motor drive control section499 and an in-field display controller 500 (mentioned later), as well asto the light emitting diode 492.

[0375] The eyepiece optical system 417 ensures simultaneous observationof the observational image of the operating microscope transmittedthrough the binocular tube optical system 412 and optional imageinformation transmitted through the image projection optical system 481.Further, the optical system 417 is designed so that it can makevisibility adjustment by moving in the direction of its optical axis Of.A motor 498 can be used for the movement in the direction of the opticalaxis Of. Numeral 499 denotes the visibility correction motor drivecontrol section that is connected to the motor 498 and the in-fielddisplay controller (mentioned later). The control section 499 isprovided with a driver circuit for the motor 498 and a control circuitfor controlling the drive of the motor. The motor 498 and the visibilitycorrection motor drive control section 499 constitute visibilitycorrection motor drive means.

[0376] The in-field display controller 500 is connected to the LCDdisplay 482, the measurement section 496, a switch 502 that is connectedto the operating microscope apparatus, a motor (not shown) for themovable prism 485, and an external image apparatus. The controller 500comprises a motor drive control circuit for the prism 485, a displaycontrol circuit, and a driving signal output circuit for driving themeasurement section. The display control circuit displays an image onthe LCD display 482 and displays a stored fixed-view display pattern formeasurement in response to input from the switch 502.

[0377] The observational image of the operating microscope according tothe present embodiment and the image displayed on the LCD display 482are observed through the eyepiece optical system 417 in the sameprocesses of operation of the twelfth and thirteenth embodiments. Theimages can be observed in the same manner as in the conventionaloperating microscope if the movable prism 485 is removed from theoptical path.

[0378] The following is a description of visibility adjustment.

[0379] If the operator turns on the switch 502 of the operatingmicroscope apparatus, the in-field display controller 500 displays thepreviously stored fixed-view display pattern on the LCD display 482.This image is observed through the image projection optical system 481and the eyepiece optical system 417 by the operator. The operator's eyesare fixed as they gaze steadily at the fixed-view display pattern. Atthe same time, the controller 500 causes the measurement section 496 tostart measuring the refractive force.

[0380] The following is a description of operation for the refractiveforce measurement.

[0381] In response to a signal from the measurement section 496,infrared light is emitted from the light emitting diode 492. Thisinfrared light is projected on the operator's eyeground via a slit (notshown) of the slit plate 490, half-mirror 489, dichroic mirror 486,movable prism 485, and eyepiece optical system 417. Thus, a slit imageof the slit plate 490 is projected on the eyeground.

[0382] The projected infrared light is reflected by the eyeground anddelivered to the light receiving element 495 via the eyepiece opticalsystem 417, the movable prism 485, the dichroic mirror 486, thehalf-mirror 489, a mirror 493, and the shielding member 494. Based oninformation on the light quantity distribution from the light receivingelement, the measurement section computes the refractive force of theoperator's eyes. Based on the result of this computation, the visibilitycorrection motor drive control section causes the motor 498 to rotate,thereby moving the eyepiece optical system 417 for a required distancein the direction of the optical axis Of. Thereupon, the operator'svisibility adjustment is completed.

[0383] The operating microscope of the present embodiment has a verysimple construction, since the image projection optical system, whichcan display another image in the field, and the optical systems(measurement optical system and light receiving optical system) formeasuring the refractive force share some of their components. Since theoptical path separate from the one for the observational image of theoperating microscope is used, moreover, the observational performance ofthe microscope cannot be ruined.

[0384] Since the fixed-view display that causes the operator to gazesteadily at the image is made on the LCD display screen, furthermore,accurate measurement can be accomplished without being influenced by thefocusing capability of the eyes.

[0385] Further, the observational performance of the operatingmicroscope cannot be lowered if the movable prism is removed from theoptical path.

FIFTEENTH EMBODIMENT

[0386] According to a fifteenth embodiment shown in FIGS. 52 to 53B, animage of a nerve monitor device that displays the nerve state of apatient in the field of an operating microscope during a surgicaloperation. The present embodiment differs from the twelfth embodimentonly in the construction of the in-field display controller.

[0387] As shown in FIG. 52, an in-field display controller 510 of thepresent embodiment is connected to a binocular tube 409 that is similarto the one according to the twelfth embodiment. A nerve monitor device511 displays a wavy image indicative of the nerve state on a monitor(not shown), and delivers a video signal for the wavy image to thecontroller 510. Further, the monitor device 511 is provided withabnormal signal output means through which the operator can be informedof change of the nerve state. The output means is connected to thecontroller 510.

[0388] The in-field display controller 510 is composed of drivercircuits for a motor 425 a for moving the movable prism 424 of thetwelfth embodiment and a motor 425 b for driving the variable-scaleoptical system 422, control circuits that are supplied with signals fromthe abnormal signal output means from the nerve monitor device 511 andcontrols the drive of the motors 425 a and 425 b, and a display controlcircuit that is supplied with a video signal from the monitor device 511and displays an image on an LCD display 420.

[0389] In the operating microscope according to the present embodiment,an image 515 of the nerve monitor device 511 is normally displayed inthe field of the operating microscope in the manner shown in FIG. 53Aduring the surgical operation. If the nerve state of the patient ischanged during the operation, a signal is outputted from the abnormalsignal output means of the monitor device 511, whereupon the in-fielddisplay controller 510 drives the motors 425 a and 425 b in the samemanner as in the twelfth embodiment. In consequence, the nerve monitorimage 515 is displayed wide, as shown in FIG. 53B.

[0390] Thus, the operator can easily recognize the nerve state of thepatient.

[0391] According to the operating microscope of the present embodiment,therefore, the size of the display information of the nerve monitordevice varies despite the operator's concentration on the surgicaloperation, so that the operator never overlooks the change of thepatient's nerve state.

[0392] The following is a description of rigid scope systems accordingto three alternative embodiments that are applicable to the surgicalsystem described above. These embodiments are solutions to the rigidscopes described in Jpn. UM Appln. KOKAI Publications Nos. 5-78201 and56-176703, U.S. Pat. No. 5,168,863, and Jpn. Pat. Appln. KOKAIPublication No. 11-155798. More specifically, these alternativeembodiments are intended to improve a rigid scope that is adapted to beinserted into the body cavity under surgical microscopic observation andensure observation in the direction at a given angle to the direction ofinsertion, to prevent the rigid scope and a TV camera and a light guideconnected thereto from hindering the microscopic observation or surgicaloperation, and to enable the operator to observe desired positions withease.

SIXTEENTH EMBODIMENT

[0393] A system according to a sixteenth embodiment will now bedescribed with reference to FIGS. 54 and 55.

[0394]FIG. 54 shows a general configuration of a rigid scope system. InFIG. 54, numeral 601 denotes a body of an operating microscope. Themicroscope body 601 is held over an affected region by means of an armstand (not shown) in a manner such that its observational direction canbe changed freely. Numeral 602 denotes a rigid scope, which comprises aninsert member 603 adapted to be inserted into the affected region (bodycavity) and having an objective lens and an internal light guide(mentioned later) fixed therein, a coupling portion 604 composed offirst and second bent portions 604 a and 604 b, and a grip portion 605having an eyepiece. Symbol R designates a point of observation of therigid scope 602.

[0395] An upper surface 604 c of the coupling portion 604 is coated withlight absorbing paint such as matte black. The grip portion 605 hastherein a camera connecting portion, which is connectable with a TVcamera 606 that is connected optically to an imaging lens (mentionedlater).

[0396] Numeral 607 denotes an external light guide, one end of which isconnected to a light source unit (not shown). A connector 607 a on theother end of the light guide 607 can be attached to and detached from alight guide mouthpiece 608 that projects substantially parallel to thebending direction of the first bent portion 604 a, at the upper end ofthe insert portion 603 of the rigid scope 602.

[0397] The construction of the rigid scope 602 will now be described indetail with reference to FIG. 55. An objective lens 609 is provided inthe distal end portion of the insert portion 603. The lens 609 is fixedobliquely to the distal end of the insert portion 603 so that it isinclined at a given angle α to the longitudinal direction of the insertportion 603. A prism 610 and a relay optical system 611 are alsoarranged in the insert portion 603. The respective optical axes of theobjective lens 609 and the optical system 611 are kept at the aforesaidangle α with the prism 610 between them.

[0398] A prism 612 is located in the first bent portion 604 a of thecoupling portion 604, whereby an observational optical axis O1 of therelay optical system 611 can be bent at about 90°. A relay opticalsystem 613 is provided in an intermediate portion of the couplingportion 604, and a prism 614 is disposed in the second bent portion 604b of the coupling portion 604. The prism 614 serves to bend theobservational optical axis, bent by means of the prism 612, so as toextend substantially in the longitudinal direction of the insert portion603. Further, the grip portion 605 has therein a relay optical system615 located on a luminous flux that is guided by means of the prism 614.An imaging lens 616 is disposed in the rear end portion of the gripportion 605. The lens 616 serves to focus an observational luminous fluxon an image-pickup device 617 of the TV camera 606.

[0399] A cable 618 that is connected electrically to the image-pickupdevice 617 of the TV camera 606 is connected to a drive unit (notshown), and a TV monitor (not shown) is connected electrically to thedrive unit. The TV camera 606 is detachably connected to the gripportion 605 by means of a mounting screw portion 619.

[0400] In the vicinity of the objective lens 609, an illuminating lens620 is disposed in the distal end of the insert portion 603. The distalend of an internal light guide 621 is fixed to the inside of the lens620 in a manner such that it is situated on the optical axis of the lens620 and that the respective centers of the guide 621 and the lens 620are substantially aligned with each other. The illuminating lens 620 andthe internal light guide 621 constitute an illumination optical systemaccording to the present embodiment. In a space portion 622 that isdefined at the junction between the insert portion 603 and the couplingportion 604, the light guide 621 is fixed to the light guide mouthpiece608 with some slack. The light guide mouthpiece 608 is formed having amounting screw portion 623 that serves to connect the external lightguide 607 optically to the internal light guide 621.

[0401] The coupling portion 604 is provided with a bearing portion 624,which engages a flange 625 on the rear end of the insert portion 603 soas to hold the insert portion 603 for rotation around its longitudinalcentral axis. The bearing portion 624 and the flange 625 constitute arotation mechanism portion 626.

[0402] With the arrangement described above, the operator operates thearm stand (not shown) that supports the operating microscope body 601,thereby adjusting the microscope body 601 to a desired position andangle. Further, illumination light is applied to the affected regionthrough the microscope body 601, and the affected region is subjected toenlarged-scale observation.

[0403] Then, the observational dead-angle region R of the operatingmicroscope in the affected region is observed by means of the rigidscope 602. First, the connector 607 a of the external light guide 607 isconnected to the light guide mouthpiece 608 of the rigid scope 602, andthe other end of the light guide 607 is connected to the light sourceunit (not shown). Further, the cable 618 of the TV camera 606 isconnected to the drive unit (not shown).

[0404] As shown in FIG. 54, the insert portion 603 is inserted into theaffected region with the grip portion 605 and the TV camera 606 kept ata distance L from the microscope body 601, and the objective lens 609 isdirected to a position near the observational dead-angle region R.

[0405] The illumination light emitted from the light source (not shown)guided to the observational dead-angle region R by means of the externallight guide 607, internal light guide 621, and illuminating lens 620.The light from the region R is transmitted through the objective lens609, prism 610, and relay optical system 611, and then bent at about 90°by means of the prism 612. After it is transmitted through the relayoptical system 613, moreover, the light is bent in the same direction asthe longitudinal direction of the insert portion 603 by means of theprism 614, and focused on the image-pickup device 617 of the TV camera606 via the relay optical system 615 and the imaging lens 616. A videoimage of the observational dead-angle region R is displayed on the TVmonitor (not shown) by means of the drive unit (not shown) and observedby the operator.

[0406] Then, in changing the observational position of the rigid scope602 from the observational dead-angle region R within a planeperpendicular to the direction of insertion of the insert portion 603,the operator operates the rotation mechanism portion 626 to rotate theinsert portion 603 in the direction of an arrow 627 shown in FIG. 55with respect to the coupling portion 604. As this is done, the rotationof the insert portion 603 is absorbed by the slack of the internal lightguide 621 in the space portion 622, so that the light guide 621 cannever be pulled. Thus, the observational position of the rigid scope 602can be changed without changing the respective positions of the couplingportion 604 and the grip portion 605 with respect to the operatingmicroscope body 601.

[0407] As the operator's treatment advances, it sometimes may behindered by the coupling portion 604, grip portion 605, TV camera 606,etc. during the observation of the observational dead-angle region R. Inthis case, the coupling portion 604 is rotated reversely in thedirection of the arrow 627 with respect to the insert portion 603 bymeans of the rotation mechanism portion 626. Thus, the respectivepositions of the grip portion 605, coupling portion 604, external lightguide 607, and TV camera 606 with respect to the operating microscopebody 601 can be changed without changing the observational position ofthe rigid scope 602.

[0408] According to the present embodiment, the grip portion 605 islocated at the fixed distance L from the insert portion 603 with thecoupling portion 604 between them. If the rigid scope 602 is insertedinto the affected region (body cavity) under surgical microscopicobservation, therefore, the microscope body 601, grip portion 605, andTV camera 606 can avoid interfering with each other. Since the externallight guide 607 that is connected to the light source unit is guided inthe same direction as the coupling portion 604, moreover, it can beprevented from unexpectedly intercepting the microscopic field. Thus,the light guide 607 exerts no bad influence upon the microscopicobservation.

[0409] Since the length of projection of the grip portion 605 and the TVcamera 606 within the plane of the affected region is restricted to theminimum, e.g., the distance L, furthermore, the space required by theoperator's surgical operation is reasonable, and the possibility of theprojecting part hindering the operation can be minimized.

[0410] Further, the observational direction of the rigid scope 602 canbe changed without changing the respective positions of the grip portion605 and the TV camera 606. When the observational direction of the rigidscope 602 is changed, therefore, the grip portion 605 and the TV camera606 can be prevented from interfering with the operator's hands or body,and the external light guide 607 and the TV camera cable 618 can beprevented from intercepting the microscopic field. Thus, the efficiencyof the surgical operation cannot be lowered. Since the respectivepositions of the grip portion 605 and the TV camera 606 can be changedwithout changing the observational position of the rigid scope 602,moreover, change of a style can be quickly tackled with the progress ofthe operation, so that the efficiency of the operation is improvedfurther.

[0411] Moreover, the upper surface 604 c of the coupling portion 604 iscoated with light absorbing paint such as matte black. If the couplingportion 604 gets into the surgical microscopic field, therefore, theillumination light of the operating microscope can be prevented frombeing reflected by the coupling portion 604 and dazzling in themicroscopic field.

[0412] In connection with the present embodiment, furthermore, thecoating method, e.g., matte black coating, has been described asreflection preventing means on the upper surface 604 c of the couplingportion 604. However, satin finish, filling, or other means forrestraining reflection may be used with the same result.

[0413] With the arrangement in which the insert portion and the gripportion are coupled by means of the coupling portion so as to bend likea crank, as in the case of the sixteenth embodiment or the embodimentsmentioned later, a plurality of rigid scopes 602 with different squintdirections for the insert portion 603 may be prepared, or a jointstructure may be provided such that a plurality of rigid scopes orinsert portions with different squint directions can be attached anddetached for replacement. According to the sixteenth embodiment, thesquint direction is opposite to the direction of the coupling portion(and the direction of the mouthpiece for the external light guide 607)against the grip portion. Alternatively, however, the direction of thecoupling portion 604 or the mouthpiece for the external light guide 607may be shifted around the axis of the insert portion. Rigid scopes ofthe conventional type may be available with various angular relationsbetween the squint direction and the direction of the lateral mouthpiecefor the external light guide.

SEVENTEENTH EMBODIMENT

[0414] A system according to a seventeenth embodiment will now bedescribed with reference to FIGS. 56 to 58. In the description of thepresent embodiment to follow, like reference numerals are used todesignate the same portions of the sixteenth and seventeenthembodiments, and a description of those portions is omitted.

[0415]FIG. 56 shows a general configuration of a rigid scope system. Thepresent embodiment is related mainly to an arm-type stand 630 forfixedly locating the rigid scope 602 in the operator's desired angularposition.

[0416] The arm-type stand 630 for holding the rigid scope 602 comprisesa first arm 631 that can be connected to the grip portion 605 of therigid scope 602. The first arm 631 is connected to a second arm 632 bymeans of a connecting portion 633 for rotation around axes O2 and O3.Likewise, the second arm 632 is connected to a third arm 634 by means ofa connecting portion 635 for rotation around an axis O4, and the thirdarm 634 is connected to a stand holder 636 by means of a connectingportion 637 for rotation around an axis O5.

[0417] The axis O2 is the center line of the first arm 631 that extendsat right angles to a reflected light axis O1′ (mentioned later) of therigid scope 602, and the axis O3 extends at right angles to the axis O2.The axis O4 extends at right angles to the center line of the second arm632, while the axis O5 extends at right angles to the axis O4.

[0418] The third arm 634 is supported vertically on the stand holder 636and connected thereto for up-and-down motion. The holder 636 can beattached integrally to a side rail of an operating table (not shown).

[0419] Each of the connecting portions 633, 635 and 637 has anelectromagnetic lock (brake, not shown) therein. The rotation aroundeach of the axes O2 to O5 can be allowed by turning on an input switch(not shown) on the distal end of the first arm 631, for example, and itcan be prohibited by turning off the input switch.

[0420] All of the first to third arms 631, 632 and 634 have a hollowstructure. The cable 618 of the TV camera 606, an arm light guide 638(mentioned later), etc. are passed through the respective bores of thesearms. The cable 618 and the guide 638 are exposed downward to theoutside from the lower surface of the connecting portion 637. The cable618 and the arm light guide 638, like the ones according to thesixteenth embodiment, can be connected to a drive unit and a lightsource unit (not shown).

[0421] The construction of the rigid scope 602 will now be described indetail with reference to FIG. 57. In FIG. 57, numeral 640 denotes amirror that is fixed in the first bent portion 604 a of the couplingportion 604. The mirror 640 serves to bend a luminous flux, guided bythe insert portion 603, at about 90° to the longitudinal direction ofthe insert portion 603. A relay optical system 641 is fixed in thecoupling portion 604. Located in the middle of the coupling portion 604is a mirror 642, which bends the luminous flux guided by the opticalsystem 641 and guides it to the imaging lens 616. The mirror 642 isfixed in the second bent portion 604 b of the coupling portion 604 in amanner such that an extension of the reflected light axis O1′ crossesthe optical axis O1 of the relay optical system 611, which issubstantially in line with the central axis of the insert portion 603,in the vicinity of the objective lens 609. The reflected light axis O1′is substantially in line with the central axis of the grip portion 605.

[0422] The insert portion 603 is provided with an internal light guide643, which, in conjunction with the illuminating lens 620, constitutesan illumination optical system. One end of the guide 643 is connectedoptically to the lens 620. The rear end portion of the guide 643 is ledout in the same direction as the bending direction of the first bentportion 604 a in a manner such that it is attached integrally to a lightguide mouthpiece 644 on the rear end of the insert portion 603 by meansof a sheathing 645. A connecting portion 646 is provided on the otherend of the internal light guide 643. Further, the guide. 643 can befixed to the underside of the coupling portion 604 by means of hooks647.

[0423] A connecting portion 648 is provided on the rear end portion ofthe grip portion 605. The connecting portion 648 engages a mountingportion 649 on the first arm 631 of the arm-type stand 630, and ispositioned by being fixed to the arm 631 by means of a so-called clickmechanism that includes a groove portion 650 and a fixing ball 651 .Thus, the rigid scope 602 can be attached integrally to the stand 630.The TV camera 606 can be also attached integrally to the first arm 631of the stand 630 so that its image-pickup device 617 is located in theimaging position of the imaging lens 616.

[0424] The connecting portion 648 of the grip portion 605 is providedwith a bearing portion 652 that engages a flange 653. The bearingportion 652 constitutes a rotation mechanism portion 654 for holding thecoupling portion 604 for rotation around the axis O1′.

[0425] As mentioned before, moreover, the arm light guide 638 isincorporated in the arms that constitute the arm-type stand 630. One endof the guide 638 is fixed by means of a light guide mouthpiece 656 atthe distal end of the first arm 631. The mouthpiece 656 has a mountingscrew portion 657 that engages the connecting portion 646 to beconnected optically to the internal light guide 643.

[0426] As shown in FIG. 58, the upper surface 604 c of the couplingportion 604 has slopes 658 and 659 that are inclined at right angles totheir longitudinal direction.

[0427] With this arrangement, the operator observes the observationaldead-angle region R of the operating microscope by means of the rigidscope 602, as in the case of the sixteenth embodiment. First, theoperator holds the grip portion 605 of the rigid scope 602 and insertsthe scope 602 into an affected region. Then, the operator, holding thegrip portion 605, turns on the input switch (not shown) on the first arm631. Thereupon, the electromagnetic locks in the connecting portions ofthe arm-type stand 630 are disengaged, so that the rotation around eachof the axes O2 to O5 is allowed, and the rigid scope 602 can be operatedfreely. In this state, the objective lens 609 of the rigid scope 602 islocated on the extension of the axis O1′ that corresponds to the axis ofthe grip portion 605. Accordingly, the operator can insert the insertportion 603 into the affected region and locate the objective lens 609near the observational dead-angle region R with a feeling such that therigid scope is a conventional rod-shaped scope without the couplingportion 604 and in a manner such that the grip portion 605 and the TVcamera 606 are kept at the distance L from the microscope body 601, asin the case of the sixteenth embodiment.

[0428] When the objective lens 609 is located in the observationaldead-angle region R, the operator then turns off the input switch on thearm-type stand 630. Thereupon, the respective electromagnetic locks ofthe connecting portions are fixed, and the rigid scope 602 is fixed withthe objective lens 609 kept near the region R. If the coupling portion604 then gets into the microscopic field of the microscope body 601, asshown in FIG. 58, the illumination light from the body 601 is reflectedaway from the microscopic field by the slopes 658 and 659 of thecoupling portion 604, as indicated by arrows W1 and W2 in FIG. 58.

[0429] The illumination light emitted from the light source (not shown)is guided to the observational dead-angle region R by means of the armlight guide 638, internal light guide 643, and illuminating lens 620.The light from the region R is transmitted through the objective lens609, prism 610, and relay optical system 611, and then bent at about 90°by means of the mirror 640. After it is transmitted through the relayoptical system 641, moreover, the light is bent in the direction of theaxis O1′ by means of mirror 642, and focused on the image-pickup device617 of the TV camera 606 via the relay optical system 615 and theimaging lens 616. A video image of the observational dead-angle region Ris displayed on a TV monitor (not shown) by means of the drive unit (notshown) and observed by the operator.

[0430] Then, in changing the observational position of the rigid scope602 from the observational dead-angle region R within a planeperpendicular to the direction of insertion of the insert portion 603,the operator operates the rotation mechanism portion 654 to rotate thecoupling portion 604 in the direction of an arrow 660 shown in FIG. 57with respect to the grip portion 605. As this is done, the internallight guide 643 is rotated integrally with the coupling portion 604around the axis O1′, since it is guided in the same direction as thebending direction of the first bent portion 604 a and fixed integrallyto the coupling portion 604 by means of the hooks 647. Thus, theobservational position of the rigid scope 602 can be changed withoutchanging the respective positions of the grip portion 605, TV camera606, and arm-type stand 630.

[0431] If the operator's treatment is hindered by the grip portion 605,coupling portion 604, TV camera 606, and arm-type stand 630 during theobservation of the observational dead-angle region R as it advances, asin the case of the sixteenth embodiment, the grip portion 605 is rotatedreversely in the direction of the arrow 660 with respect to the couplingportion 604 by means of the rotation mechanism portion 654. Thus, therespective positions of the grip portion 605, the TV camera 606, and thearms that constitute the arm-type stand 630 with respect to theoperating microscope body 601 can be changed without changing theobservational position of the rigid scope 602.

[0432] Depending on the conditions of the region to be observed,moreover, the operator must change the rigid scope 602 during a surgicaloperation. The rigid scope may be selected among ones of which theobservational angle α of the objective lens 609 to the longitudinaldirection of the insert portion 603 is different or the outside diameterof the insert portion 603 varies depending on the diameter of theopening of the body cavity to be penetrated thereby. In this case, theoperator first loosens the mounting screw portion 657 to remove theconnecting portion 646 of the internal light guide 643 from the lightguide mouthpiece 656. Further, the operator, holding the grip portion605 in one hand and the first arm 631 in the other, pulls out the rigidscope 602 in the direction of an arrow 661 from the first arm 631.Thereupon, the groove portion 650 of the connecting portion 648 isdisengaged from the pin 651 of the first arm 631, and the rigid scope602 is removed from the first arm 631.

[0433] Subsequently, a preferred rigid scope that is different from theone described above in the observational angle α and the outsidediameter of the insert portion 603 is attached to the first arm 631,reversely following the aforementioned steps of procedure, and is usedin the same manner as aforesaid. According to the present embodiment,the grip portion 605 is located at the fixed distance L from the insertportion 603 with the coupling portion 604 between them, as in the caseof the sixteenth embodiment. Therefore, the surgical operationmicroscope body 601, grip portion 605, and TV camera 606 can avoidinterfering with one another. Further, the length of projection of thegrip portion 605 and the TV camera 606 within the plane of the affectedregion is restricted to the minimum or the distance L, and besides, theinternal light guide 643 is guided in the same direction as the bendingdirection of the first bent portion 604 a and fixed to the underside ofthe coupling portion 604. Accordingly, the internal light guide 643 canbe securely prevented from wrongly intercepting the microscopic fieldduring the surgical operation.

[0434] Since the objective lens 609 of the rigid scope 602 is located onthe axis of the grip portion 605, moreover, the operator can adjust theobservational position of the rigid scope with the same feeling ofoperation as that for a conventional rigid scope without the couplingportion 604, and locate the objective lens 609 more quickly and securelyin the target region. Since the cable 618 of the TV camera 606 and thelight guides are incorporated in the holding arm for fixedly holding therigid scope 602 itself, furthermore, the whole rigid scope system neverunduly occupies the space for the operator's surgical operation, and theefficiency of the surgical operation can be prevented from lowering.

[0435] Since the observational direction of the rigid scope 602 can bechanged by only rotating the coupling portion 604 with the length L,moreover, the grip portion 605 and the TV camera 606 can be preventedfrom interfering with the operator's hands or body when theobservational direction is changed. Since the respective positions ofthe grip portion 605, the TV camera 606, and the arms of the arm-typestand 630 can be changed without changing the observational position ofthe rigid scope 602, furthermore, change of the style can be quicklytackled with the progress of the operation, so that the efficiency ofthe operation is improved further.

[0436] Since the rigid scope 602 can be easily replaced with a new oneduring the surgical operation, moreover, an optimum rigid scope can beselected according to the progress of the operation, so that theefficiency of the operation is improved additionally.

[0437] Furthermore, the upper surface 604 c of the coupling portion 604is composed of the slopes 658 and 659. If the coupling portion 604 getsinto the field of the operating microscope, therefore, the illuminationlight of the operating microscope is reflected to the outside of themicroscopic field and prevented from entering the field. Thus, theillumination light can be prevented from dazzling in the field of theoperating microscope.

EIGHTEENTH EMBODIMENT

[0438] A system according to an eighteenth embodiment will now bedescribed with reference to FIGS. 59 to 61. In the description of thepresent embodiment to follow, like reference numerals are used todesignate the same portions of the sixteenth to eighteenth embodiments,and a description of those portions is omitted.

[0439]FIG. 59 shows a general configuration of a rigid scope system. InFIG. 59, numeral 670 denotes an arm-type stand for holding the rigidscope 602. The stand 670 is obtained by modifying only the distal endportion of the first arm 631 of the arm-type stand 630 according to theseventeenth embodiment. More specifically, the TV camera 606 is held ina distal end portion 672 of a first arm 671, and the cable 618 is housedin the arms 671, 632 and 634 without being exposed to the outside. Thegrip portion 605 of the rigid scope 602 is provided with a control knob673 for changing the observational direction.

[0440] The rigid scope 602 will now be described in detail withreference to FIG. 60. An image guide 674, formed of a light guide fiber,is fixedly incorporated in the coupling portion 604. One end of theimage guide 674 is connected optically to the relay optical system 611in the insert portion 603 at the first bent portion 604 a, while theother end of the guide 674 is connected optically to the relay opticalsystem 615 in the grip portion 605 at the second bent portion 604 b.

[0441] In the present embodiment, as in the seventeenth embodiment, theobjective lens 609 is located in a position near the point ofintersection of an extension of the optical axis O1′ of the relayoptical system 615, which is substantially in line with the central axisof the grip portion 605, and the optical axis O1 of the relay opticalsystem 611, which is substantially in line with the central axis of theinsert portion 603.

[0442] In FIG. 60, numeral 675 denotes a light guide fixing portion,which serves to fix one end of the arm light guide 638 in the first arm671. A connecting light guide 676 is held in the grip portion 605 andthe coupling portion 604. One end of the light guide 676 is fixed in aconnecting portion 677 of the grip portion 605 so as to be connectedoptically to the arm light guide 638. The other end portion 678 of theconnecting light guide 676 is circumferentially located so as to coverthe outer periphery of the image guide 674 in the first bent portion 604a, and is fixed in the coupling portion 604 so as to be guided in thesame direction as the bending direction of the first bent portion 604 a.

[0443] In the insert portion 603, on the other hand, an internal lightguide 679, which is connected optically to the illuminating lens 620, iscircumferentially located so as to cover the outer periphery of therelay optical system 611. In the first bent portion 604 a, the internallight guide 679 is circumferentially fixed so as to be connectedoptically to the connecting light guide 676. The illuminating lens 620,internal light guide 679, and connecting light guide 676 constitutes anillumination optical system according to the present embodiment.

[0444] Provided in the grip portion 605, moreover, is a cylindricalmember 680 that is attached to the coupling portion 604 for rotationaround a shaft 681. The cylindrical member 680 is coupled with theobservational direction changing control knob 673 on the grip portion605. As shown in FIG. 61, a gear 682 is provided integrally on the outerperiphery of the cylindrical member 680.

[0445] In the coupling portion 604, on the other hand, a gear 680 inmesh with the gear 682 is rotatably supported on a shaft 684. In thefirst bent portion 604 a, moreover, a gear 686 is provided in mesh withthe gear 683. The gear 686, in conjunction with a bearing portion 687 inthe housing of the coupling portion 604, constitutes a rotationmechanism portion 688.

[0446] With this arrangement, as in the cases of the sixteenth andseventeenth embodiments, the operator observes the observationaldead-angle region R of the surgical microscope by means of the rigidscope 602. First, the electromagnetic locks in the arm-type stand 670are disengaged with the grip portion 605 of the rigid scope 602 held inposition, the objective lens of the rigid scope 602 is moved to theobservational dead-angle region R, and the electromagnetic locks of thestand 670 are worked again to hold and fix j rigid scope 602. In thisstate, as in the case of the second embodiment, the objective lens 609of the rigid scope 602 is located on the extension of the axis O1′ thatcorresponds to the axis of the grip portion 605. Accordingly, theoperator can position the rigid scope 602 with a feeling such that therigid scope is a conventional one without the coupling portion 604.

[0447] Illumination light emitted from a light source (not shown) isguided to the observational dead-angle region R by means of the armlight guide 638, connecting internal light guide 676, and illuminatinglens 620. After the light from the region R is transmitted through theobjective lens 609, prism 610, and relay optical system 611, it isguided to the relay optical system 615 in the grip portion 605 by meansof the image guide 674 in the coupling portion 604 and focused on theimage-pickup device 617 of the TV camera 606. Thereupon, a video imageof the observational dead-angle region R is displayed on a TV monitor(not shown) by means of a drive unit (not shown) and observed by theoperator.

[0448] Then, in changing the observational position of the rigid scope602 from the region R, the operator turns the observational directionchanging control knob 673 in the direction of an arrow 690. As the knob673 rotates, the gear 682 also rotates in the direction of the arrow 690around the shaft 681, so that the engaging gears 683 and 686 alsorotate. Thereupon, the insert portion 603 is rotated in its central axisor the optical axis O1 by means of the rotation mechanism portion 688that is composed of the gear 686 and the bearing portion 687, wherebythe observational direction of the objective lens 609 is changed. Inthis state, the internal light guide 679 and the connecting light guide676 are circumferentially connected around the relay optical system 611that has the optical axis O1. Accordingly, there is no possibility ofthe light guides being pulled or the illumination light suffering a lossas the insert portion 603 rotates. Thus, the illumination light isguided to the observational region, and the observational position ofthe rigid scope 602 is changed without changing the respective positionsof the grip portion 605, TV camera 606, arm-type stand 670, etc.

[0449] If the operator's treatment is hindered by the grip portion 605,coupling portion 604, TV camera 606, and arm-type stand 670 during theobservation of the observational dead-angle region R as it advances, theaforementioned processes of operation are carried out the other wayaround. The rotation mechanism portion 688 is operated by means of theobservational direction changing control knob 673 to change theobservational direction of the objective lens 609. Thereafter, thearm-type stand 670 is operated to redirect the objective lens 609 to theobservational dead-angle region R. Then, respective positions of thegrip portion 605, the TV camera 606, and the arms that constitute thearm-type stand 670 are changed without. moving the observationalposition of the rigid scope 602 from the region R.

[0450] In replacing the rigid scope 602 with one that is different inthe observational angle and the outside diameter of the insert portion,as in the case of the seventeenth embodiment, the operator, holding thegrip portion 605 in one hand and the first arm 671 in the other, pullsout the grip portion 605 of the rigid scope 602 in the direction of anarrow 691 from the first arm 671. Thereupon, the groove portion 650 ofthe connecting portion is disengaged from the pin 651 in the distal endportion 672 of the first arm 671, and the rigid scope 602 is removedfrom the arm-type stand 670.

[0451] Then, the rigid scope that is different in the observationalangle α and the outside diameter of the insert portion 603 is attachedto the first arm 631, reversely following the aforementioned steps ofprocedure. As this is done, the connecting light guide 676 is fixed in aposition (position shown in FIG. 60) where it is connected optically tothe arm light guide 638 by means of the groove portion 650 and the pin651.

[0452] The present embodiment has the following effects as well as theeffects of the fifth embodiments. Since the cable 618 of the TV camera606 and the light guides can be incorporated in the rigid scope 602 andthe arm-type stand 670, the whole rigid scope system never undulyoccupies the space for the operator's surgical operation, and cables canbe prevented from coiling around the operator's hands during theoperation of the rigid scope 602. Thus, the efficiency of the rigidscope 602 itself can be improved.

[0453] Further, the observational direction of the rigid scope 602 canbe changed by operating the observational direction changing controlknob 673 on the grip portion 605. Thus, the observational direction canbe easily changed one-handed according to the operation of the rigidscope 602.

[0454] Since the light guides need not be attached or detached when therigid scope is replaced during a surgical operation, the rigid scope canbe changed more quickly, so that the efficiency of the surgicaloperation is enhanced.

[0455] According to the present embodiment, the gears are used as meansfor connecting the observational direction changing control knob 673 andthe rotation mechanism portion 688. It is to be understood, however,that the gears may be replaced with any other suitable motiontransmitting mechanism, such as a wire belt or cam mechanism, with thesame result.

[0456] The present invention is not limited to the embodiments describedherein. According to the description of the foregoing embodiments,systems of the following particulars and optional combinations thereofcan be obtained at the least.

[0457] In short, the rigid scope according to any of the sixteenth toeighteenth embodiments, having the observational optical system and theillumination optical system therein, comprises the insert portion, gripportion, and coupling portion that couples the insert and grip portions.The coupling portion includes the first and second bent portions, andthe illumination optical system is guided in the same direction as thebending direction of the first bent portion.

[0458] This rigid scope is inserted into and fixed in the affectedregion under surgical microscopic observation without allowing its gripportion to interfere with the body of the operating microscope.Accordingly, the TV camera, cables, etc. can be securely prevented frominterfering with the microscope body or intercepting the microscopicfield.

[0459] The rigid scope may be provided with a rotation mechanism portionthat can hold the insert portion and/or the grip portion for rotationwith respect to the coupling portion.

[0460] In this case, the rigid scope can be inserted into and fixed inthe affected region under surgical microscopic observation withouthaving its grip portion interfere with the body of the operatingmicroscope, and the position of observation by means of the rigid scopecan be changed without changing the position of the rigid scope withrespect to the operating microscope body. Therefore, the operator canset the observational position (or direction) in the affected region andthe respective positions of the TV camera, light guides, holding arm,etc. in his or her desired relation. Further, the rigid scope can belocated optimally depending on the location of the operating microscopeand the operator's treatment style and method, changes during thesurgical operation can be quickly tackled, and besides, the efficiencyof the surgical operation can be enhanced considerably.

[0461] Moreover, a light guide that is connected to the illuminationoptical system may be detachably connected near the junction between theinsert portion and the coupling portion.

[0462] Furthermore, a connecting portion to which the light guideconnected to the illumination optical system is detachably connected maybe provided in the vicinity of the grip portion.

[0463] Preferably, the respective central axes of the grip portion andthe insert portion extend substantially parallel to each other.

[0464] Preferably, moreover, the objective lens should be fixed in theinsert portion near an extension of the central axis of the gripportion.

[0465] The rotation mechanism portion should preferably be provided onthe grip portion or the coupling portion.

[0466] An operating portion for operating the rotation mechanism portionshould preferably be provided on the grip portion.

[0467] Reflection preventing means may be provided on thegrip-portion-side surface of the coupling portion. Preferably, thispreventing means is formed of a slope.

[0468] The following is a description of an endoscopic surgical systemin an alternative form.

[0469]FIG. 72 shows the conventional endoscopic surgical system thatincludes a squint-type rigid scope 701. This endoscopic surgical systemcomprises a TV camera system 702 formed of a TV camera head 702 a and acontroller 702 b, monitor 703 for displaying an image picked up by meansof the camera system 702, light source unit 704 for supplyingillumination light to the rigid scope 701, and light guide 705. Duringthe surgical operation, the rigid scope 701 is fixedly supported bymeans of a scope holder 706. The TV camera head 702 a is connected tothe rigid scope 701 in a manner such that the lower and upper parts ofthe display screen of the monitor 703 correspond to the deep side(distal end side) and the shallow side (hand side), respectively, withrespect to the direction of insertion of the rigid scope 701. Anoperator 700 operates an instrument 707 to perform extraction of atumor, hemostasis, etc. while watching an endoscopic observational imageon the monitor 703.

[0470] Described in Jpn. Pat. Appln. KOKAI Publication No. 7-328015, forexample, is a surgical manipulator that remotely operates the instrumentunder endoscopic observation in place of an operator. If the operatoroperates this surgical manipulator, a treatment manipulator is thenactuated by means of an actuator, whereupon an affected region istreated. Further, the operator gets a display device on his or her headso that s/he can watch a display image thereon as s/he operates themanipulator to carry out a surgical operation. In this case, theoperator's head is detected, and the observational position of theendoscope is moved correspondingly.

[0471] In FIG. 72, the rigid scope 701 is used to observe a region onthe left of the operator 700, and a rigid scope image is displayed onthe monitor 703. If the operator moves the instrument 707 to the right(in the direction of arrow D1) on the monitor 703 while watching theimage displayed on the monitor 703 in these conditions, the actualinstrument 707 is moved forward or away from the operator (in thedirection of arrow d1). If the operator 700 moves the instrument 707 tothe left (in the direction of arrow B1) on the monitor 703, on the otherhand, the actual instrument 707 is moved toward the operator (in thedirection of arrow b1).

[0472] In order to move the instrument 707 on the monitor 703 to theright or left (in the direction of arrow D2 or B2) as the rigid scope inthe state of FIG. 72 is turned counterclockwise for 90° to observe theoperator side, as shown in FIG. 73, the operator 700 is expectedactually to move the instrument 707 in the opposite direction whencompared to the image on the monitor 703. Thus, in a surgical operationusing an endoscope of which the observational direction is differentfrom the direction of its insertion, the direction of actual movement ofthe instrument is not coincident with the moving direction of theinstrument on the monitor. Accordingly, the operator must deliberate onthe direction of the instrument to be moved while watching the monitoror confirm the moving direction by delicately moving the instrument todetermine the direction in which the instrument is to be moved next.Therefore, the operation time is so long that the operator is fatiguedinevitably. The operator can solve this problem by shifting his or herposition relative to the affected region, depending on the observationaldirection of the endoscope, so that the operator's frontal direction iscoincident with the observational direction. It is hard to attain this,however, since the instrument may interfere with a patient's body orsome other surgical device.

[0473] On the other hand, the system described in Jpn. Pat. Appln. KOKAIPublication No. 7-328015 is designed to detect the operator's head inmoving the endoscopic field. This system, however, is large-scaled andnot easy to handle. In order to change the observational position of theendoscope, moreover, the operator's body or head must be moved.Therefore, this system is an effective measure for remote-controlledoperation. Since the operating room is furnished with a lot ofinstruments and cables, however, the use of this system in the operatingroom is obstructive and narrows the range of the operator's movement. Ifthe endoscope rotates around the course of insertion, moreover, thedirection of the display image observed by the operator changesinevitably. Thus, the direction in which the master manipulator is to bemoved is deviated from the direction in which the manipulator fortreatment moves on the display image.

[0474] Accordingly, there is a demand for an endoscopic surgical systemdesigned so that the manipulating direction of the instrument withrespect to the operator's position is coincident with the movingdirection of the instrument even if the observational direction of theendoscope is changed, whereby the operation time can be shortened, andthe operator's fatigue can be eased.

[0475] FIGS. 62 to 71 show embodiments of endoscopic surgical systemsthat can fulfill these requirements.

[0476] The endoscopic surgical system shown in FIG. 62 comprises a rigidscope 801, TV system 803 formed of a TV camera head 803 a and acontroller 803 b attached to the hand-side portion the rigid scope 801,and monitor 805. An optical axis 813 of an objective lens 802 that isprovided on the distal end of the rigid scope 801 is inclined at anangle a to a central axis O1 of an insert portion 801 a of the rigidscope 801. An observational image that is obtained through the objectivelens 802 is picked up by means of an image-pickup device (not shown) ofthe TV camera head 803 a through the medium of a relay optical systemand an imaging optical system (not shown). The TV camera head 803 acauses the controller 803 b to display the observational image on themonitor 805. In FIG. 62, numeral 806 denotes a light guide that isconnected to a light source unit (not shown) for supplying illuminationlight to the field of the rigid scope 801. The TV camera head 803 isconnected to the rigid scope 801 in a manner such that the lower andupper parts of the display image of the monitor 805 correspond to thedeep side (distal end side) and the shallow side (hand side),respectively, with respect to the direction of insertion of the rigidscope 801.

[0477] In FIG. 62, numeral 807 denotes a flexible scope holder forsupporting the rigid scope 801. It is fixed to a bedside stay (notshown). The scope holder 807 supports the rigid scope 801 for rockingmotion around the central axis O1. In FIG. 62, numeral 808 denotes aninstrument 808. The instrument 808 is fixed integrally to the insertportion 801 a of the rigid scope 801 by means of a connecting member812. The instrument 808 includes an input portion 809 for the operator'smanipulation and an output portion 810 that operates in response to themanipulation of the input portion 809. Further, the instrument 808 isfitted with a bipolar probe 811 that is adapted to arrest bleeding orcoagulate blood in an affected region when a high-frequency current issupplied across electrodes. The instrument 808 is connected to the rigidscope 801 in a positional relation such that the output portion 810extends along the optical axis 813 of the scope 801 to ensureimage-pickup operation by means of the scope 801 at all times.

[0478]FIGS. 63 and 64 show a specific configuration of the instrument808. As shown in FIG. 63, the instrument 808 includes a lower chassis808 a connected integrally to the insert portion 801 a of the rigidscope 801 by means of the connecting member 812, upper chassis 808 brockably connected to the lower chassis 808 a, and a joint 808 c thatconnects the lower and upper chassis 808 a and 808 b. The upper chassis808 b can rock around an axis O3 that extends substantially parallel tothe central axis O1 of the insert portion 801 a of the rigid scope 801.

[0479] The input portion 809 is provided with a hollow input lever 815.The lever 815 includes a small-diameter grip portion 815 a on the handside (operator side) and a disk-shaped displacement portion 815 b on thedistal end side. The input lever 815 is formed having a narrow hole 815c and a recess 815 d in the form of a spherical depression, locatedsuccessively from the hand side in the order named. The bipolar probe811 is inserted in the hole 815 c. One end of a flexible tube 816, whichhas an inside diameter equal to the diameter of the hole 815 c, isconnected to the terminal end of the hole 815 c (or the boundary betweenthe hole 815 c and the recess 815 d). The bipolar probe 811 is insertedfor axial movement in the tube 816. One end of an upper support shaft817 is fixed integrally to the upper chassis 808 b. The other end of theshaft 817, having a spherical shape, is fitted in the recess 815 d ofthe input lever 815, thereby supporting the distal end side of the lever815 so that the lever 815 can tilt around its central portion T1. Theupper support shaft 817 has a hollow structure that is penetrated by thetube 816.

[0480] As is also shown in FIG. 64, one end of each of four wires 820 ato 820 d is fixed to the displacement portion 815 b of the input lever815. The wires 820 a to 820 d are fixedly arranged at angular spaces of90° on the circumference of a circle with a radius r around the axis O4that passes through the central portion T1. On the other hand, one endof each of four hollow flexible hoses 821 a to 821 d is connected tothat part of the upper chassis 808 b which faces the displacementportion 815 b. The positions where the hoses 821 a to 821 d areconnected correspond to the four positions where the wires 820 a to 820d are fixed, respectively. The wires 820 a to 820 d are passed for axialmovement in their corresponding hoses 821 a to 821 d.

[0481] The output portion 810 is provided with a hollow output lever825. The lever 825 includes a small-diameter portion 825 a on the distalend side (affected region side) and a disk-shaped displacement portion825 b on the side farther from the affected region. The output lever 825is formed having a narrow hole 825 c and a recess 825 d in the form of aspherical depression, located successively from the affected region sidein the order named. The bipolar probe 811 is inserted in the hole 825 c.The flexible tube 816, which has the inside diameter equal to thediameter of the hole 825 c, is connected to the terminal end of the hole825 c (or the boundary between the hole 825 c and the recess 825 d).

[0482] One end of a lower support shaft 827 is fixed integrally to thelower chassis 808 a. The other end of the shaft 827, having a sphericalshape, is fitted in the recess 825 d of the output lever 825, therebysupporting the lever 825 so that the lever 825 can tilt around itscentral portion T2. The lower support shaft 827 has a hollow structurethat is penetrated by the tube 816.

[0483] The respective other ends of the four wires 820 a to 820 d arefixed to the displacement portion 825 b of the output lever 825. Thewires 820 a to 820 d are fixedly arranged at angular spaces of 90° onthe circumference of a circle with the radius r around an axis O4 thatpasses through the central portion T1. Further, the respective otherends of the hoses 821 a to 821 d are connected to that part of the lowerchassis 808 a which faces the displacement portion 825 b. The positionswhere the other ends of the hoses 821 a to 821 d are connectedcorrespond to the four positions where the wires 820 a to 820 d arefixed, respectively. As shown in FIG. 64, in this case, the wires 820 ato 820 d and the hoses 821 a to 821 d are fixed to the displacementportion 825 b and the lower chassis 808 a in a manner such that thearrangement around the axis O4 on the side of the input portion 809 isrotated for 180° to realize the arrangement around the axis O5.

[0484] The following is a description of the operation of the endoscopicsurgical system constructed in this manner.

[0485] When the rigid scope 801 is directed forward from the operatorside, the observational image that is picked up by means of the scope801 and the TV camera system 803 is displayed on the TV monitor 805, asshown in FIG. 65.

[0486] The bipolar probe 811 can be actually moved in the directions ofarrows A3, B3, C3 and D3 on the screen of the monitor 805 bycorrespondingly tilting the input lever 815 in the directions of arrowsa3, b3, c3 and d3. For example, the probe 811 can be moved to the righton the monitor 805 by tilting the lever 815 to the right. Thus, it isnecessary only that the input lever 815 be tilted in a desired directionwith reference to the image on the monitor 805.

[0487] In moving the distal end of the bipolar probe 811 in thedirection of arrow A3 (or upward) on the monitor 805, for example, theinput lever 815 is moved in the direction of arrow a3 (or upward).Thereupon, the lever 815 tilts around the central portion T1 withrespect to the upper support shaft 817, so that the wire 820 c is pulledto the hand side, while the wire 820 a is pushed out to the distal endside (or loosens). The pushed wire 820 a advances in the hose 821 a,thereby causing the output lever 825 to tilt in the direction of arrowa3 around the central portion T2. Thus, the distal end of the bipolarprobe 811 moves in the direction of arrow A3 on the monitor 805. Forother directions, the system operates in the same manner. Morespecifically, if the input lever 815 is moved in the direction of arrowb3 (or to the left), the output lever 825 tilts in the direction ofarrow b3, and the bipolar probe 811 moves in the direction of arrow B3on the monitor 805. If the input lever 815 is moved in the direction ofarrow c3 (or downward), the output lever 825 tilts in the direction ofarrow c3, and the probe 811 moves in the direction of arrow C3 on themonitor 805. If the input lever 815 is moved in the direction of arrowd3 (or to the right), the output lever 825 tilts in the direction ofarrow d3, and the probe 811 moves in the direction of arrow D3 on themonitor 805. Moreover, the operator 700 can advance or retreat thebipolar probe 811 to a target region by moving it toward or away fromthe input lever 815. As this is done, the probe 811 advances or retreatsin the tube 816 so that it projects or recedes from the distal end ofthe output lever 825.

[0488] The following is a description of the operation of the instrument808 for the case where the rigid scope 801 is rotated counterclockwisefor 90° around the axis O1 with respect to the operator 700 (case wherethe operator's left-hand side is observed, see FIG. 66).

[0489] If the rigid scope 801 is rotated counterclockwise for 90°, asshown in FIG. 66, the instrument 808 also rotates counterclockwise for90° in one with the scope 801. Since the position of the operator 700relative to an affected region never changes during a surgicaloperation, however, the operator 700 can restore the input lever 815 tobe operated to the position right in front of him or her by rotating theupper chassis 808 b for 90° in the direction of arrow M with respect tothe lower chassis 808 a. Thus, the output lever 825 is deviated at 90°from the input lever 815. Even in this case, however, the optical axis813 of the rigid scope 801 and the output portion 810 of the instrument808 are already moved integrally with each other, so that the relationshown in FIG. 65 is maintained between the moving direction of theoutput lever 825 of the instrument 808 on the monitor 805 and themanipulating direction of the input lever 815. Thus, the output lever825 or the bipolar probe 811 can be appropriately moved by tilting theinput lever 815 in a desired direction to move the instrument 808 on themonitor 805, only if the monitor 805 is located right in front of theoperator 700 and if the input lever 815 of the instrument 808 isdirected frontally (or toward the operator) as it is used.

[0490] According to the rigid scope system described above, change ofthe observational direction of the rigid scope 801 is transmittedmechanically to the instrument 808 to change the direction of the outputwith respect to the input with the scope 801 and the instrument 808connected integrally with each other. Therefore, the construction of thesystem is simple and never hinders surgical operations. Since themanipulation of the input portion 809 is transmitted to the outputportion 810 by means of the flexible wires and hoses, moreover, thesystem can enjoy a simple configuration without requiring use of anycomplicated mechanisms.

[0491] According to the present embodiment, the instrument 808 is fixedintegrally to the insert portion 801 a of the rigid scope 801.Alternatively, however, it may be fitted on the insert portion 801 a ofthe rigid scope 801, as in the case of the sheathing of a conventionalendoscope, or may be formed having a bipolar probe or the like insertedtherein, as in the case of the present embodiment.

[0492]FIG. 67 shows a modification. In this modification, the scopeholder 807 is fixed mechanically to the upper chassis 808 b by means ofa rotation regulating member 830. According to this arrangement, theinput portion 809 never fails to be situated right in front of theoperator if the rigid scope 801 is rotated around the axis O1. Thus, theoperation time can be shortened.

[0493] FIGS. 68 to 70 show another embodiment. In the description of thepresent embodiment to follow, like reference numerals are used todesignate those components which are common to the present embodimentand the embodiment shown in FIGS. 62 to 67, and a description of thoseportions is omitted.

[0494] As shown in FIG. 68, an endoscopic surgical system according tothe present embodiment comprises a scope holder 840 that supports therigid scope 801 for sliding motion in X-, Y-, and Z-axis directions. Theholder 840 is fixed to a bedside stay 841 a. The holder 840 includes arigid scope connecting member 842. The connecting member 842 is providedwith angle detecting means 843 for detecting the rotational angle of therigid scope 801 compared to the scope holder 840. The detecting means843, which is formed of an encoder 844 (see FIG. 70), serves to detectthe rotational angle of the insert portion 801 a of the scope 801 aroundthe central axis O1.

[0495] Further, this endoscopic surgical system comprises an instrumentholder 845 that holds the instrument 808 for sliding motion in the X-,Y-, and Z-axis directions. The holder 845, which is fixed to a bedsidestay 841 b, includes an instrument connecting member 846 for supportingthe instrument 808.

[0496] As shown in FIG. 69, the instrument connecting member 846 on thedistal end portion of the instrument holder 845 includes a gear 847 thatis fixed to the lower chassis 808 a of the instrument 808 in anonrotatable manner. The gear 847, along with the connecting member 846,restrains the lower chassis 808 a from moving along the axis O3 andholds it for rocking motion around the axis O3 at the joint 808 c. Onthe other hand, the upper chassis 808 b is restrained from rockingaround the axis O3 by means of a pin 852 that is attached to theconnecting member 846.

[0497] The instrument connecting member 846 is provided with a motor 848that is fixed to a holding member 899. A gear 849 in mesh with the gear847 is fixed coaxially to an output shaft 848 a of the motor 848. Theinput and output portions 809 and 810 of the instrument 808 and themechanism for transmitting their motions are constructed in the samemanner as the ones according to the first embodiment.

[0498] As shown in FIG. 70, the encoder 844 that constitutes the angledetecting means 843 is connected to a control circuit 850. The circuit850 is connected to a motor driver circuit 851 that is connected to themotor 848. In response to an input signal from the encoder 844, thecontrol circuit 850 delivers a given signal to the driver circuit 851according to predetermined conditions, in order to rock the instrument808 around the axis O3 in the same direction and at the same angle asthe rotation of the rigid scope 801 around the central axis O1.

[0499] The following is a description of the operation of the endoscopicsurgical system constructed in this manner.

[0500] If the rigid scope 801 is rotated around the axis O1, therotational angle of the rigid scope 801 compared to the rigid scopeconnecting member 842 is detected by means of the encoder 844 of theangle detecting means 843, and angle information is delivered to thecontrol circuit 850. Based on this angle information, the controlcircuit 850 computes the rotational angle of the rigid scope 801, anddelivers a signal to the motor driver circuit 851 to rotate theinstrument 808 for the same angle. In response to this input signal, thedriver circuit 851 causes the motor 848 to rotate for a required amount.The rotation of the motor 848 is transmitted to the lower chassis 808 awith the gear 847 in mesh with the gear 849 that is fixed coaxially tothe output shaft 848 a, whereupon the chassis 808 a rotates for the sameangle as the rigid scope 8O1. Thus, the observational direction of thescope 801 and the direction of the output portion 810 of the instrument808 have the same relation as in the embodiment shown in FIGS. 62 to 67.In this state, the upper chassis 808 b is prevented from rotating withrespective to the instrument connecting member 846 by the agency of thepin 852. Therefore, the position of the input portion 809 compared tothe operator 700 never changes. Accordingly, the direction of theoperator's manipulation of the instrument 808 can be made to coincidewith the moving direction of the instrument 808 on the monitor 805. Ifthe output portion 810 of the instrument 808 is deviated from the rangeof observation as the rigid scope 801 rotates around the central axisO1, the instrument 808 is moved in the X-, Y-, and Z-axis directions foradjustment by means of the instrument holder 845.

[0501] As described above, the present embodiment, unlike the embodimentshown in FIGS. 62 to 67, is designed so that the rotation of the rigidscope 801 around the direction of insertion is detected electrically,and the output portion 810 of the instrument 808 is rotatedelectrically. Therefore, the scope 801 and the instrument 808 can beheld separately from each other, so that they can be inserted fromdifferent directions into different positions, depending on theconditions of the surgical operation. Thus, the system of the presentembodiment can cope with a wide variety of styles of surgicaloperations.

[0502] According to the present embodiment, moreover, the rotation ofthe rigid scope 801 is detected by means of the encoder 844.Alternatively, however, it may be detected by means of conventionaloptical position detecting means, which is designed so that anilluminant is connected to the rigid scope 801, its image is picked upby means of image-pickup means (TV camera), and the position androtational angle of the rigid scope are computed in accordance with theresulting image-pickup signal. Thus, the position detection can beeffected even without the use of any scope holder.

[0503]FIG. 71 shows still another embodiment. The rigid scope 801, TVcamera system 803, monitor 805, scope holder 840, and rotational angledetecting means for detecting the position of the rigid scope 801 withrespect to the holder 840, according to the present embodiment, areconstructed in the same manner as the ones according to the foregoingembodiment, so that a description of those components is omitted. Thefollowing is a description of an instrument 863, a component of analternative construction, only.

[0504] In FIG. 71, numeral 860 denotes a slave manipulator (hereinafterreferred to as treatment manipulator) that has the instrument 863 fixedon its distal end and is attached to the bedside stay 841 b. Thetreatment manipulator 860 is composed of a first operating arm 860 a foruse as a support mechanism movable in the vertical direction and turningdirection, a second operating arm 860 b attached to the first arm 860 aand movable in the horizontal direction, and a joint portion 860 cattached to the distal end portion of the second arm 860 b. Further, thetreatment manipulator 860 is connected, by means of a manipulatorcontrol device 861 and a direction changing circuit 865, to a mastermanipulator 862 in a region that is accessible to the operator.

[0505] As is generally known, the manipulator control device 861receives a signal from the master manipulator 862 and delivers a drivingsignal to the treatment manipulator 860 such that the manipulator 860moves in the same manner as the manipulator 862 does.

[0506] The direction changing circuit 865 is connected with an encoder844 that constitutes the same angle detecting means 843 as aforesaid. Onreceiving an input signal from the encoder 844, the circuit 865 changesa signal from the manipulator control device 861 according to a giventransformation formula, and delivers a driving signal for changing theoperating direction of the treatment manipulator 860, compared to themanipulation of the master manipulator 862, to the manipulator 860.

[0507] The first and second operating arms 860 a and 860 b of thetreatment manipulator 860 have the drive structure of a manipulator of aso-called cylindrical-coordinate type, formed of vertical, turning, andhorizontal operation axes e, f and g that are activated by means ofactuators (not shown), such as electromagnetic motors. Alternatively,however, the operating arms may have the structure of a so-calledmulti-joint manipulator formed of a plurality of joint portions. Thejoint portion 860 c is connected to the instrument 863 so that it can beactuated by means of an actuator, such as an electromagnetic motor, totilt the instrument 863 around two axes h and i that extend at rightangles to each other.

[0508] The following is a description of the operation of the endoscopicsurgical system constructed in this manner.

[0509] A distal end position Q of the instrument 863 that is connectedto the treatment manipulator 860 is known by means of the manipulatorcontrol device 861, based on the respective operating positions of thevertical, turning, horizontal, and tilting axes e, f, g, h and i and thegeometric dimensions of the individual members. On the other hand, theposition of a point of action 862 a of the master manipulator 862 isobtained by computation by means of the manipulator control device 861.A signal is delivered from the control device 861 to the directionchanging circuit 865 such that the instrument distal end Q moves to theposition of the point of action 862 a of the master manipulator 862. Asin the case of the foregoing embodiment, moreover, the observationaldirection of the rigid scope 801 is detected by means of the encoder 844of the angle detecting means 843 and transmitted to the directionchanging circuit 865.

[0510] Based on the signal from the encoder 844, the direction changingcircuit 865 computes the input signal from the manipulator controldevice 861 according to a previously stored computational formula, anddelivers a driving signal to the treatment manipulator 860 such that themanipulating direction of the master manipulator 862 is alwayscoincident with the moving direction of the instrument 863 on themonitor 805. Thus, the signal is delivered to the treatment manipulator860 so that the moving direction of the distal end position Q of theinstrument 863 displayed on the screen of the monitor 805 is coincidentwith the manipulating direction of the master manipulator 862, as in thecase of the foregoing embodiment. Thereupon, the direction of theoperator's manipulation of the instrument 863 is coincident with themoving direction of the instrument 863 on the monitor 805.

[0511] According to the present embodiment, as described above, theinstrument 863 can be remotely manipulated by means of the mastermanipulator 862, so that the operator can carry out a surgical operationin any convenient position without restrictions on the location of themanipulator 862. Thus, the operator can perform the operation in a morecomfortable posture.

[0512] In short, the endoscopic surgical systems described withreference to FIGS. 62 to 71 comprises an endoscope capable ofobservation in directions different from the direction of its insertion;image-pickup means connected to the endoscope and capable of picking upan observational image of the endoscope; display means for displayinginformation from the image-pickup means; an instrument including aninput portion for an operator's manipulation, an output portion adaptedto operate in response to the manipulation of the input portion, andoperating direction changing means capable of changing the operatingdirection of the output portion with respect to the input portion; andcontrol means adapted to operate the operating direction changing meansas the direction of observation around the direction of insertion of theendoscope changes.

[0513] In this system, the control means drives the operating directionchanging means to control the operating direction of the output portionof the instrument with respect to the direction of manipulation of theinput portion, in response to vertical and horizontal shifts of anaffected region on the display means caused when the endoscope rotatesaround the direction of insertion. The operating direction of the outputportion of the instrument on the display means is controlled so that itis always coincident with the direction of actual manipulation of theinput portion of the instrument. Thus, if the operator manipulates theinput portion of the instrument in the same direction as the directionin which the output portion of the instrument is expected to move, whilewatching the display means, the output portion moves in the intended orexpected direction on the display means. Accordingly, the movingdirection need not be considered or confirmed during the surgicaloperation. In consequence, the manipulation of the instrument is easy,the operation time is shortened, and therefore, the operator's fatiguecan be eased.

[0514] Preferably, the operating direction changing means includesmanipulation transmitting means for transmitting the manipulation of theinput portion to the output portion and a rotating portion capable ofrotating the output portion around the direction of insertion of theinstrument into the affected region, with respect to the input portion,and the control means includes rotation transmitting means fortransmitting the rotation around the direction of insertion of theendoscope, thereby rotating the rotating portion. When the endoscoperotates around the direction of insertion, in this case, the rotationtransmitting means rotates the rotating portion of the instrument.Thereupon, the output portion rotates around the direction of insertionwith respect to the input portion of the instrument. In this state, themanipulation transmitting means transmits the manipulation of the inputportion to the output portion, so that the operating direction of theoutput portion is changed with respect to the input operation.

[0515] The manipulation transmitting means may be mechanicaltransmitting means.

[0516] In the case where the rotation transmitting means is providedwith a connecting member for connecting the endoscope and the instrumentintegrally to each other, the connecting member causes the instrument torotate integrally with the rigid scope so that the rotating portion ofthe instrument rotates when the endoscope rotates around the directionof insertion. Thereupon, the output portion rotates in the direction ofinsertion with respect to the input portion of the instrument. In thisstate, the manipulation transmitting means transmits the manipulation ofthe input portion to the output portion, so that the operating directionof the output portion is changed with respect to the input operation.

[0517] Preferably, the rotation transmitting means includes rotationdetecting means for detecting the rotational displacement of theendoscope in the direction of insertion with respect to a given region,drive means capable of rotating the rotating portion, and electricalcontrol means for controlling the drive of the drive means in accordancewith a signal from the rotation detecting means. In this case, therotation of the endoscope around the direction of insertion is detectedby the rotation detecting means and applied to the electrical controlmeans. Based on this input signal, the electrical control means drivesthe drive means to rotate the rotating portion. Thereupon, the outputportion rotates in the direction of insertion with respect to the inputportion of the instrument. In this state, the manipulation transmittingmeans transmits the manipulation of the input portion to the outputportion, so that the operating direction of the output portion ischanged with respect to the input operation.

[0518] The rotation detecting means may be an encoder.

[0519] Preferably, moreover, the rotation detecting means is providedwith an optical illuminant, second image-pickup means for picking up animage of the optical illuminant, and optical position detecting meansincluding computing means for computing the rotational angle of theendoscope in accordance with a signal from the second image-pickupmeans.

[0520] The drive means may be a motor.

[0521] The mechanical transmitting means may be provided with a firstflexible member and a second flexible member capable of being displacedrelatively to the first flexible member. Preferably, the first flexiblemember is a wire, and the second flexible member is a hose fitted on thewire.

[0522] Further, there may be provided an endoscopic surgical systemcomprising an endoscope capable of lateral observation; image-pickupmeans connected to the endoscope and capable of picking up anobservational image of the endoscope; display means for displayinginformation from the image-pickup means; an instrument including amaster manipulator for an operator's manipulation, a slave manipulatoradapted to operate in response to the manipulation, and manipulatorcontrol means for controlling the slave manipulator so that the slavemanipulator operates following the master manipulator; rotationdetecting means for detecting the rotational displacement of theendoscope around the direction of insertion, and manipulator operatingdirection changing means for controlling the operating direction of theslave manipulator in accordance with information from the manipulatorcontrol means and the rotation detecting means.

[0523] Additional advantages and modifications will readily occur tothose skilled in the art. Therefore, the invention in its broaderaspects is not limited to the specific details and representativeembodiments shown and described herein. Accordingly, variousmodifications may be made without departing from the spirit or scope ofthe general inventive concept as defined by the appended claims andtheir equivalents.

What is claimed is:
 1. An observation apparatus comprising: an opticalmicroscope for observing an optical image of an object in a field ofview of the optical microscope, the optical microscope including a firstoptical system for forming the optical image of the object; a firstdisplay capable of displaying a first image which is different from theoptical image; a second optical system for optically transmitting thefirst image to display the first image in the field of view of theoptical microscope; a second display capable of displaying a secondimage which is different from the optical image and the first image, anda third optical system for optically transmitting the second image todisplay the second image in the field of view of the optical microscope.2. The observation apparatus according to claim 1, wherein the secondoptical system is configured to superpose the first image on a part ofthe optical image.
 3. The observation apparatus according to claim 2,wherein the third optical system is configured to superpose the secondimage on a part of the optical image.
 4. The observation apparatusaccording to claim 1, wherein the second optical system forms aprojection optical system for projecting the first image on a part ofthe optical image.
 5. The observation apparatus according to claim 4,wherein the third optical system forms a projection optical system forprojecting the second image on a part of the optical image.
 6. Theobservation apparatus according to claim 1, further comprising acomputer electrically connected to the first display, wherein thecomputer controls a size of the first image displayed on the firstdisplay so as to change a size of the first image displayed in the fieldof view in accordance with a magnification of the optical image observedby the optical microscope.
 7. The observation apparatus according toclaim 1, wherein the first image is an image obtained by one selectedfrom the group consisting of an endoscope, a rigid scope and anultrasonic diagnostic apparatus.
 8. The observation apparatus accordingto claim 1, wherein: the first image is an image of the object obtainedby means of an observation unit selected from the group consisting of anendoscope and an ultrasonic probe; and the first image and the secondimage include one of (i) a combination of the first image obtained bymeans of the observation unit and an image indicative of an observationposition or direction of the observation unit and (ii) a combination ofa preoperative/mid-operative diagnostic image selected from the groupconsisting of image-processed fluorescent observational images obtainedby means of the observation unit and the image,indicative of theobservational position or direction of the observation unit and a tumorposition display marker image.
 9. The observation apparatus according toclaim 1, wherein the second image is a marker image.
 10. An operatingmicroscope apparatus comprising: an observational optical system forforming an optical image of an object including an affected region;observational means capable of observing the optical image in a field ofview of the observational optical system; first display means forobservably displaying a first image different from the optical image inthe field of view of the observational means; and second display meansfor observably displaying a second image different from the opticalimage and first image in the field of view of the observational means.11. The operating microscope apparatus according to claim 10, whereinthe first display means includes a display which displays the firstimage and an image projection optical system which projects the firstimage into the field of view.
 12. The operating microscope apparatusaccording to claim 11, wherein the image projection optical systemprojects a part of the optical image and the first image.
 13. Theoperating microscope apparatus according to claim 10, wherein the seconddisplay means includes an image superposition optical system whichsuperposes an image on a part of the optical image.
 14. The operatingmicroscope apparatus according to claim 10, further comprising switchingmeans which independently switches display/non-display of the first andsecond images of the object.
 15. The operating microscope apparatusaccording to claim 10, wherein: the first image is an image of theobject obtained by means of object observing means selected from thegroup consisting of an endoscope and an ultrasonic probe; and the firstand second images include one of (i) a combination of the first imageobtained by means of the object observing means and an image indicativeof an observational position or direction of the object observing meansand (ii) a combination of a preoperative/mid-operative diagnostic imageselected from the group consisting of image-processed fluorescentobservational images and the image indicative of the observationalposition or direction of the object observing means and a tumor positiondisplay marker image.
 16. A surgical observational system comprising: anobservational optical system for forming an optical image of an objectincluding an affected region; first observational means for observingthe optical image; a memory which stores a preoperative diagnostic imageof the object including the affected region; second observational meanswhich obtains an image showing a desired area of the object, the desiredarea found in the optical image, the second observational means beingdifferent from the first observational means in at least one ofobservational direction and observational method; detecting means whichdetects the relative position of the first and second observationalmeans in three dimensions; first display means which displays the imageshowing the desired area of the object obtained by the secondobservational means on the optical image observed by the firstobservational means in accordance, with the relative position of thefirst and second observational means in three dimensions; and seconddisplay means which reads out the preoperative diagnostic imageincluding the desired area from the memory and displays the preoperativediagnostic image on the optical image observed by the firstobservational means in accordance with the relative position of thefirst and second observational means in three dimensions.
 17. Thesurgical observational system according to claim 16, wherein the secondobservational means is one selected from the group consisting of anendoscope, rigid scope and ultrasonic diagnostic apparatus.
 18. Asurgical observational system comprising: a first observationalapparatus including a first optical system which forms an optical imageof an object; a second observational apparatus different from the firstobservational apparatus in at least one of observational direction andobservational method, the second observational apparatus obtaining animage showing a desired area of the object, the desired area found inthe optical image; a first display capable of displaying the imageshowing the desired area of the object obtained by the secondobservational apparatus; a second optical system optically coupled tothe first optical system, the image showing the desired area of theobject displayed on the first display entering into the second opticalsystem, being superposed on the optical image and observed by the firstobservational apparatus; a memory which stores a preoperative diagnosticimage of the object; a second display capable of displaying thepreoperative diagnostic image; a third optical system optically coupledto the first optical system, the image of the preoperative diagnosticimage displayed on the second display entering into the third opticalsystem, being superposed on the optical image and observed by the firstobservational apparatus; a detector capable of detecting the relativeposition of the first and second observational apparatuses in threedimensions; and a computer electrically connected to the first display,second display and detector, the computer controlling the displayposition of the image showing the desired area on the first display suchthat the image showing the desired area obtained by the secondobservational apparatus is superposed on the desired area of the opticalimage observed by the first observational apparatus in accordance withthe result of the detection by the detector, and the computer readingout the preoperative diagnostic image including the desired area fromthe memory in accordance with the result of the detection and displayingit on the second display.
 19. The surgical observational systemaccording to claim 18, wherein the second observational apparatus is oneselected from the group consisting of an endoscope, rigid scope andultrasonic diagnostic apparatus.
 20. The surgical observational systemaccording to claim 19, wherein the computer is further capable ofsetting the size of the image showing the desired area, the imageshowing the desired area superposed on the desired area of the opticalimage and displayed on the first display in accordance with amagnification of the optical image observed by the first observationalapparatus.